膈神经阻滞对开胸术后术侧肩部疼痛的影响

The effects of infiltrating the phrenic nerve with ropivacaine on ipsilateral shoulder pain after thoracotomy surgery

目的观察膈神经阻滞对开胸术后术侧肩部疼痛的影响。方法择期全麻下肺叶切除术患者70例,随机数字法分为两组:罗哌卡因组(R组)和对照组(C组),关闭胸腔前进行膈神经阻滞,分别给予0.25%罗哌卡因8ml(R组)或生理盐水8ml(C组)。术毕均行PCIA。记录术后2、4、8、12、24和48hVAS疼痛评分,术后术侧肩痛情况,术后24h内舒芬太尼的使用量、需补救镇痛药情况。结果与C组比较,R组术后术侧肩痛例数明显减少,术后2、4和8hVAS评分明显降低,术后24h内舒芬太尼总用量明显减少(P<0.05)。结论膈神经阻滞可以降低术后术侧肩痛的发生率。

Objective To evaluate the effects of phrenic nerve infiltration on ipsilateral shoulder pain in thoracotomy patients. Methods Seventy patients undergoing lung resection were randomly allocated into two groups. Before closing the chest, patients received infiltration of the ipsilateral phren- ic nerve with saline 8 ml （group C） and ropivaeaine 0.25% 8 ml （group R）. All patients received patient-controlled intravenous analgesia （PCIA） after operation. A blinded observer recorded VAS scores of pain and the incidence of ipsilateral shoulder pain at 2 h, 4 h, 8 h, 12 h, 24 h and 48 h after surgery. Sufentanil consumption during the first 24 h after surgery was also recorded. Results The incidence of ipsilateral shoulder pain in group R was decreased during the first 8 h after surgery （P〈 0.05）. VAS scores at 2,4,8 h after surgery were lower in group R than in group C （P〈0.05）. Compared with group C, sufentanil consumption in group R declined （P〈0.05）. Conclusion Phrenic nerve infiltration with ropivacaine reduced the incidence of ipsilateral shoulder pain during the first 8 h after open lung resection.