椎旁神经阻滞在开胸术后急、慢性疼痛管理中的应用

Evaluation on effect of paravertebral nerve block on pain management after thoracotomy

目的观察椎旁神经阻滞在开胸手术后急性、慢性疼痛治疗中的效果。方法 60例拟行择期开胸手术治疗的患者随机均分为2组,每组30例:椎旁神经阻滞组(P组)、对照组(C组)。P组:在神经刺激仪引导下行椎旁神经阻滞,药物:罗哌卡因注射液100 mg^+曲安奈德注射液10 mg^+维生素B12 1mg^+生理盐水至30 ml,注射20 ml。麻醉起效后行全麻诱导。两组患者均使用舒芬太尼静脉自控镇痛泵,于手术结束前30 min启动。观察术后48 h的VAS评分、PCA药物消耗量及按压次数、不良反应。电话随访术后2 m,4 m,6 m的VAS评分。结果 1 P组术后48 h内VAS评分均低于C组患者,差异有统计学意义(P<0.05)。2P组PCA药物消耗量及按压次数均小于C组(P<0.05)。3 C组患者阿片类药相关不良反应发生率高于P组(P<0.05)。4P组术后(2 m,4 m,6 m)慢性疼痛发生率低于C组(P<0.05)。结论舒芬太尼自控镇痛复合椎旁神经阻滞不仅可以改善开胸患者术后2 d内的急性疼痛、而且可以降低术后慢性疼痛发生率,且不增加患者风险。

Objective To compare clinical effect of nerve stimulator-guided paravertebral nerve block and patient-controlled analgesia on pain management after thoracotomy.Methods Sixty patients who would receive elective thoracotomy surgery were randomly divided into two groups：paravertebral nerve block group（group P,n=30）,control group（group C,n=30）.Patients in group P were received paravertebral nerve block before general anesthesia using ropivacaine plus Triamcinolone Acetonide plus vitamin B12 plus physiological saline.All patients were received sufentanil PCIA before completion of surgery.VAS were recorded in postoperative 48 h.Drug consumptions and press numbers of PCA in 24 h,side effects were recorded.Incidence of chronic post-surgical pain（CPSP） were investigated by telephone interview after operation.Results ①VAS in group P were significantly lower than that in group C（P〈0.05）.②The drug consumptions and press numbers of PCA in group P were significantly lower than those in group C（P〈0.05）.③There were significant differences on the incidence of side effects of opioid between group C and group P（P〈0.05）.④The incidence of CPSP in group P was significantly lower than that in group C（P〈0.05）.Conclusion PVB provided lower VAS and consumed less sufentanil in 48 h,and also gave lower incidence of CPSP without more side effects compared with control group.