超声引导下胸椎旁阻滞对全肾切除患者术后镇痛效果和恶心呕吐发生率的影响

The effects of ultrasound-guided thoracic paravertebral block on analgesia and PONV in patients undergoing nephrectomy

目的评价术前超声引导下胸椎旁阻滞(TPVB)对全肾切除患者术后镇痛效果和恶心呕吐(PONV)发生率的影响。方法前瞻性随机对照研究,对40名行全肾切除的患者,随机分为TPVB组(S组)和静脉PCA组(C组),每组20例。S组患者在术前接受超声引导下TPVB阻滞(T9-T11),每个节段注射0.5%罗哌卡因5ml。所有患者接受全麻下全肾切除手术。研究终点为术后12h内疼痛视觉模拟评分(VAS),术中芬太尼用量,术后吗啡累计用量以及术后恶心呕吐(PONV)发生率。结果 S组在术后2h、4h、6h和12h的活动VAS评分均低于C组(P<0.05);患者首次使用PCA吗啡补救镇痛的时间,S组晚于C组(185±48min v.s.50±38min,P<0.05);术后24h吗啡累计用量降低(22±8.5mg vs.68±17.3mg,P<0.05);术中芬太尼用量,S组低于C组(2.5±0.8μg/kg v.s.4.8±1.1μg/kg,P<0.05)。PONV发生率S组低于C组(23%v.s.53%,P<0.05)。结论对于全肾切除术,术前超声引导在T9-T11进行单次TPVB,能够产生良好的术后镇痛效果,降低阿片类用量和PONV发生率。

Objective To evaluate the effects of ultrasound-guided thoracic paravertebral block（TPVB）on analgesia and postoperative nausea and vomiting（PONV）in patients undergoing nephrectomy.Methods aprospective randomized controlled study.40 patients scheduled for nephrectomy were randomly assigned into two groups：Group S（TPVB）,and Group C（PCA morphine）.Group S received ultrasound-guided thoracic paravertebral block at T9-T11 levels,with 5ml of 0.5%ropivocaine at each level.All patients received general anesthesia and nephrectomy in the OR.Patients were assessed for postoperative pain score（VAS）.Intraoperative fentanyl consumption and postoperative morphine consumption were recorded.The incidence of PONV was recorded.Patients were followed-up for any complications during their hospital stay.Results Group S showed significant decrease in dynamic VAS scores within postoperative 12hours（P〈0.05）,less consumption of intraoperative fentanyl（P〈0.05）,and less postoperative morphine（P〈0.05）.Group S showed a later time of the first dose rescue morphine（P〈0.01）,and lower PONV incidence（P〈0.05）.Conclusion Ultrasound-guided TPVB results in greater postoperative analgesic effects,reduced opioids consumption and PONV incidence in patients undergoing nephrectomy.