超声引导下椎旁神经阻滞在乳腺癌根治术超前镇痛中的应用效果

Efficacy of Ultrasound-Guided Paravertebral Block for Preemptive Analgesia in Patients Undergoing Radical Mastectomy

目的评价超声引导下椎旁神经阻滞用于乳腺癌根治术患者超前镇痛的效果。方法将60例择期行乳腺癌根治术患者按随机数字表法分为2组:P组30例采用全凭静脉麻醉+术后自控静脉镇痛(PCIA);N组30例采用全凭静脉麻醉联合超声引导下椎旁神经阻滞+术后自控静脉镇痛(PCIA)。超声引导下椎旁神经阻滞方法:患者清醒时在超声引导下经T5-6行患侧椎旁神经阻滞,成功后注射实验剂量0.375%罗哌卡因5mL,无不良反应5min后注射0.375%罗哌卡因20mL,15min后测定痛觉阻滞平面。记录2组术后48h内镇痛补救情况及嗜睡、恶心呕吐、呼吸抑制、皮肤瘙痒等不良反应发生情况;比较2组麻醉用药量、气管导管拔管时间、ICU滞留时间及PCIA单位时间用药量。结果与P组比较,N组术后48h嗜睡、恶心呕吐、呼吸抑制发生率显著降低,麻醉用药量及PCIA单位时间用药量显著减少,气管导管拔管时间和ICU滞留时间显著缩短(P<0.05);2组皮肤瘙痒、术后48h镇痛补救率比较差异无统计学意义(P>0.05)。结论超声引导下椎旁神经阻滞对乳腺癌根治术患者具有良好的超前镇痛效果。

Objective To evaluate the efficacy of ultrasound-guided paravertebral block for preemptive analgesia in patients undergoing radical mastectomy.Methods Sixty patients scheduled for selective radical mastectomy were randomized into group P and group N,with 30 patients in each group.All patients received total intravenous anesthesia and postoperative patient-controlled intravenous analgesia（PCIA）.In group N,ultrasound-guided ipsilateral paravertebral block（T5-6）was additionally performed before anesthesia,and 20 mL 0.375% ropivacaine was injected 5minutes after experimental injection with 5mL 0.375%ropivacaine.The level of sensory block was measured 15 minutes after the block.Remedial analgesia,drowsiness,nausea,vomiting,respiratory depression,pruritus and other adverse effects were recorded within 48 hours after surgery.The dosage of anesthetics,endotracheal extubation time,ICU residence time and PCIA dose per unit time were compared between the two groups.Results Compared with group P,the incidence of drowsiness,nausea,vomiting and respiratory depression,dosage of anesthetics and PCIA dose per unit time were decreased,and ICU residence time and endotracheal extubation time were shortened in group N（P〈0.05）.There were no significant differences in the incidence of pruritus and rate of remedial analgesia between the two groups（P〉0.05）.Conclusion Ultrasound-guided paravertebral block is effective for preemptive analgesia in patients undergoing radical mastectomy.