胸脊神经后支压痛区局部阻滞治疗开胸术后慢性切口痛

LOCAL BLOCKAGE IN TENDER REGION DOMINATED BY POSTERIOR RAMI OF THORACIC NERVES ALLEVIATED CHRONIC PERIINCISION PAIN OF POSTTHORA-COTOMY

目的:探讨胸脊神经后支范围内压痛敏感区局部阻滞能否治疗开胸术后慢性切口痛。方法:选择25例开胸术后中、重度慢性切口痛患者,随机分为A(12例)和B(13例)两组。A组于切口上下5个节段实施肋角处肋间神经阻滞,每节段注入含有复方倍他米松的镇痛液4ml,B组在切口痛对应脊神经后支分布范围内的压痛敏感区注射相同镇痛液,每点2ml,共10点。2周后,两组均重复治疗1次。比较治疗前、治疗后1周、1月、3月时的疼痛评分(VAS)和睡眠质量指数(PSQI)。结果:治疗后,两组各时点的VAS和PSQI各项评分均比治疗前下降(P<0.05);但组间比较,B组VAS和PSQI各项评分较A组进一步下降(P<0.05),患者疼痛明显缓解,睡眠障碍显著改善。结论:胸脊神经后支内压痛敏感区局部阻滞可显著减轻开胸术后慢性切口痛。

Objective： To investigate whether local blockage in tender region dominated by the posterior rami of thoracic nerves could treat chronic periincision pain of postthoracotomy effectively. Methods： 25 patients,who suffered from severe chronic periincision pain of postthoracotomy,were divided into Group A（n=12） and Group B（n=13）.In Group A,every case received five segments of intercostal nerve block surrounding the incision.A 4ml bolus of solution containing Diprospan was injected into per segment at the costal angle.In Group B the same solution was infused into the tender region dominated by the posterior rami of thoracic nerves.A 2ml bolus of solution was injected into per point and 10 points in total.The procedure was repeated after two weeks. VAS and scores of PSQI were measured and compared between the two groups at pre-treatment,one week,one month and three months after the treatment.Results： Compared with those at pre-treatment,VAS and all scores of PSQI in Group A and B after treatment were decreased significantly（P0.05）. However,compared with in Group A,VAS and PSQI scores in Group B were declined further（P0.05）. The patients in Group B achieved better pain relief and improved sleep quality significantly. Conclusions： Local blockage in tender region dominated by the posterior rami of thoracic nerves could alleviate chronic periincision pain of postthoracotomy.