超声引导下竖脊肌平面阻滞对乳腺癌根治术后镇痛疗效评价

Ultrasound-guided erector spinae Plane Block for Breast Cancer Evaluation of analgesic effect after radical surgery

目的 评价超声引导下单次竖脊肌平面(ESP)阻滞在乳腺癌根治术后镇痛中的临床效果.方法 乳腺癌根治术患者68例,均为女性,ASAI^II级.按随机数字表法分为竖脊肌平面阻滞组(ESP组)和对照组(C组).ESP组在全身麻醉诱导前行超声引导下单次竖脊肌平面阻滞,给予0.33%罗哌卡因25~30ml,对照组常规全身麻醉诱导.两组均在全凭静脉全身麻醉下完成手术,术后两组均采用患者自控静脉镇痛(PCIA).评价术后2、6、10、14、24、48h各时间点运动和运动静息时视觉模拟评分(VAS)评分;记录镇痛泵有效按压次数、药物消耗量及皮肤瘙痒、术后恶心呕吐(PONV)等不良反应发生情况.结果 ESP组2、6、10、14、24、48h术后静息和运动时VAS评分明显低于对照组,差异有统计学意义(P<0.05);ESP组0~24h、0~48h PCIA药物总输注量和有效按压次数显著低于对照组(P<0.05);ESP组术后恶心呕吐(PONV)和皮肤瘙痒不良反应发生率明显低于C组(P<0. 05).结论 超声引导下竖脊肌平面阻滞可为乳腺癌根治术术后提供安全有效的镇痛,能明显减少阿片类药物用量并降低不良反应的发生.

Objective To evaluate the clinical effect of single dose of ultrasound-guided erector spinae plane(ESP)block for postoperative analgesia after radical mastectomy. Methods 68 cases of ASA I to II female patients received elective radical mastectomy were divided into ESP group(ESP group)and control group(C group)with randomized digital table. The ESP group was given single dose of ultrasound-guided erector spinae plane (ESP)block with 0.33% ropivacaine 25-30ml and the control group was given general anesthesia inducing. The two groups were all given intravenous-inhalation anesthesia during operation and patient-controlled intravenous analgesia(PCIA)postoperation. The visual analogue scores(VAS)of resting and moving 2,6,10,14,24,48 hours after operation,frequencies of PCIA effective pressing,quantities of PCIA infusion,skin itching and postoperative nausea and vomiting(PONV)were all recorded. Results The VAS of resting and moving 2,6,10,14,24,48 hours after operation,frequencies of PCIA effective pressing,0~24 hours and 0~48 hours quantities of PCIA infusion,skin itching and PONV in the ESP group were less than the control group significantly(P<0.05). Conclusion The ultrasound-guided erector spinae plane(ESP)block is safe and effective for postoperative analgesia after radical mastectomy,with less quantities of opioids and complications.