罗哌卡因复合芬太尼肋间神经阻滞麻醉效果及对术后镇痛的影响

Effects of intercostal nerve block with ropivacaine combined with fentanyl in breast surgery

目的观察罗哌卡因复合芬太尼用于乳腺区段切除手术中肋间神经阻滞效果及术后镇痛作用。方法选择ASAⅠ或Ⅱ级择期行乳腺肿块区段切除术的患者60例,随机分为两组,每组30例。肋间神经使用0.375%罗哌卡因(Ⅰ组)或0.375%罗哌卡因+芬太尼2μg/ml(Ⅱ组)。观察两组麻醉起效时间、阻滞完善时间、麻醉维持时间、术后24 h镇痛效果及不良反应,记录麻醉期间RR、MAP、HR及SpO2的变化。结果与Ⅰ组比较,Ⅱ组麻醉起效时间和麻醉阻滞完善时间缩短(P<0.05)、维持时间延长(P<0.01);术后4、8、12 h VAS评分Ⅱ组降低(P<0.01)。两组患者生命体征、不良反应发生率差异无统计学意义。结论芬太尼可增强罗哌卡因肋间神经阻滞麻醉的效果,延长术后镇痛时效。

Objective To observe the effects of intercostal nerve block with ropivaeaine combined with fentanyl in breast surgery patients. Methods Sixty ASA Ⅰ or Ⅱ patients undergoing selective segmental mastectomy were randomly divided into two groups with 30 each. Patients received intercostal nerve block with 0. 375% ropivacaine （group Ⅰ） or 0. 375%ropivacaine combined with fentanyl 2μg/ml（group Ⅱ）. The onset time, completely blocking time, duration of anesthesia, and postoperative analgesia 24 hours after surgery were recorded. RR, MAP, HR and SpO2 during anesthesia and side effects were also observed. Results Compared with group I, the onset time, completely blocking time were shorter（P〈0. 05）, the duration of anesthesia was longer（P〈0. 01）, and postoperative VAS was lower in groupⅡ（P〈0. 01）. There was no significant difference in the basic vital signs（RR,MAP, HR and SpO2 ） and incidence of side- effects in both groups. Conclusion Fentanyl can increase the effect of intercostal nerve block with ropivaeaine and prolong the duration of postoperative analgesia.