胸椎旁神经阻滞用于乳腺癌根治术后镇痛的临床疗效评价

Effects of an ultrasound-guided thoracic paravertebral block on postoperative analgesia in breast cancer patients after radical mastectomy

目的评价超声引导下胸椎旁神经阻滞在乳腺癌根治术后镇痛中的临床效果。方法选择接受乳腺癌根治术的女性患者60例，随机分为2组，超声引导下椎旁神经阻滞（thoracicparavertebralblock，TPVB）组和对照组，各30例。TPVB组患者在超声引导下实施胸椎旁神经阻滞，给予0．5％罗哌卡因20ml；对照组给予等量的生理盐水。两组患者在静吸复合麻醉下完成手术，术后均采用经静脉患者自控镇痛（PCIA）。评价术后1、4、8、12、24、48小时静止和运动视觉模拟评分（VAS）、舒芬太尼用量和不良反应。随访患者术后3个月和6个月慢性疼痛情况。结果TPVB组患者在术后1、4、8、12小时静止和运动VAS评分低于对照组，差异有统计学意义（P〈0．05）；两组患者术后48小时静止和术后24、48小时运动VAS评分比较差异无统计学意义；TPVB组PCIA舒芬太尼用量明显少于对照组（P〈0．01）；TPVB组患者术后恶心和呕吐的发生率分别为17．2％和6．9％，对照组分别为43．3％和26．7％，两组比较，差异有统计学意义（P〈0．05）。TPVB组术患者后3个月和6个月疼痛的发生率分别为13．8％和6．9％；对照组分别为36．7％和30％。结论超声引导下胸椎旁神经阻滞可以为乳腺癌根治术患者提供良好的术后镇痛，减少阿片类药物的用量和不良反应，降低慢性疼痛的发生率。

Objective To evaluate an ultrasound-guided thoracic paravertebral block（TPVB） on postoperative analgesia in breast cancer patients after radical mastectomy. Methods Sixty female breast cancer patients underwent radical mastectomy and were randomly divided into the TPVB group and the control group,with 30 cases in each. Patients in the TPVB group received a 20 ml of 0.5% ropivacaine under ultrasound guidance, and those in the control group received the same volume of normal saline. All patients received patient-controlled intravenous analgesia. Postoperative pain values, were recorded at 1 st, 4th,8th,12th,24th and 48th hour at rest and on movement using the Visual Analogue Scale（VAS）. The consumption of sufentanil and adverse reactions were also evaluated. The incidence of chronic pain was in- vestigated with telephone interview after 3 month and 6 month postoperatively. Results Postoperatively, at 1 st ,4th ,8th, 12th ,24th hour, patients in control group had significantly higher VAS values both at rest and on movement than those in the group treated with a thoracic paravertebral block（ P 〈 0.05 ）. The opioid consumption in TPVB group were lower than that in control group（ P 〈 0.01 ）. The incidences of nausea, vomit, and chronic pain in TPVB group were significantly lower than those in control group. Conclusion Ultrasound-guided paravertebral block can provide good postoperative analgesia effects for breast cancer patients after radical mastectomy. It reduces the opioid consumption, adverse reactions, and incidence of chronic pain. decreases postoperative pain values and the need for analgesics during the postoperative 24 hours, has obvious advantages in chronic pain relief.