超声引导前锯肌阻滞用于日间乳腺手术镇痛的效果

Analgesic effect of ultrasound-guided anterior serratus muscle block in daytime breast surgery

目的通过与超声引导下胸椎旁神经阻滞(thoracic paravertebral blockade,TPVB)比较,探讨超声引导下前锯肌平面阻滞(serratus anterior plane block,SAPB)用于日间乳腺手术的有效性和安全性。方法选取2018-12至2019-02行日间乳腺手术的患者90例,随机分为T(TPVB)组30例,S(SAPB)组30例,C(局麻)组30例。3组患者入室后建立基本生命体征监测,心率、心电图、血压、脉搏血氧饱和度,静脉泵注负荷剂量右美托米啶0.25μg/kg,10 min之内泵注完毕,并以0.05μg/kg维持剂量持续泵注,于手术结束前15 min停止。T组患者行手术侧TPVB,S组患者行手术侧SAPB,C组由手术医师行瘤体周围局部浸润麻醉。记录3组患者局麻药补救次数;记录3组患者术后1 h(T1)、术后2 h(T2)、术后4 h(T3)、术后6 h(T4)VAS评分;记录3组患者术后不良反应的发生情况及神经阻滞组操作用时。结果T组、S组患者麻醉补救次数均显著少于C组(P<0.05),T组、S组患者麻醉补救次数比较,差异无统计学意义;3组患者术后T1 VAS评分差异无统计学意义,T组、S组患者T2、T3、T4 VAS评分均低于C组(P<0.05),T组、S组患者T2、T3、T4 VAS评分比较,差异无统计学意义;C组、S组患者术后并发症(寒战、恶心呕吐、相应区域肌肉疼痛)发生率明显低于T组(P<0.05),C组、S组患者术后并发症差异无统计学意义;S组患者神经阻滞操作用时明显少于T组(P<0.05)。结论超声引导下SAPB镇痛效果确切,安全性高,可用于日间乳腺手术麻醉镇痛。

Objective To explore the effectiveness and safety of the ultrasound-guided serratus anterior plane block(SAPB)for daytime breast surgery.Methods Ninety patients who underwent breast surgery between December 2018 and February 2019 were randomly and equally divided into group T(TPVB),group S(SAPB),and group C(control).The three groups of patients were monitored for such basic vital signs as heart rate,electrocardiograms,blood pressure and pulse oximetry after entering the ward.The venous pump was loaded with dexmedetomidine 0.25μg/kg that was pumped in 10 minutes,followed by a constant infusion of 0.05μg/kg that was suspended 15 minutes before the end of the operation.Patients in group T underwent the surgical paravertebral nerve block,those in group S underwent the serratus anterior plane block,and those in group C underwent local anesthesia around the tumor.The number of times of local anesthetic remedies were used in the three groups was recorded,so were the VAS scores of the three groups at h(T1),2 h(T2),4 h(T3),and 6 h(T4)after surgery.The incidence of postoperative adverse reactions in the three groups was recorded,so was the duration of surgery in the nerve block group.Results There was no significant difference in postoperative T1 VAS scores between the three groups.The T2,T3,and T4VAS scores of groups T and S were significantly lower than those of group C(P<0.05).There was no significant difference in T3 and T4 VAS scores between patients in group T and group S.Anesthesia remedies were used significantly less frequently in group T and group S than in group C(P<0.05).There was no significant difference in the number of times anesthesia remedies were used between group T and group S.The rate of postoperative complications(chilling,nausea and vomiting,corresponding regional muscle pain)in group C and S was significantly lower than in group T(P<0.05).There was no significant difference in postoperative complications between group C and group S.Nerve block operation took much less time in group S than in group T(P<0.05).Conclusions The analgesic effect of the serratus anterior muscle block under ultrasound guidance is remarkable,and can be safely used in daytime breast surgery.