超声引导下阴部神经阻滞用于PPH术后镇痛的效果观察

Improved technique of ultrasound-guided pudendal nerve block for PPH postoperative pain management

目的介绍一种改良的超声引导下阴部神经阻滞方法,并比较局部浸润麻醉和超声引导下阴部神经阻滞用于吻合器痔上黏膜环切术术后镇痛效果。方法拟在腰麻下行择期PPH术的60例混合痔患者纳入本研究。随机分为超声引导下阴部神经阻滞组(perineum nerve block,PNB组)和局麻镇痛组(local anaesthesia,LA组),每组30例患者。手术结束后,PNB组患者实施超声引导下PNB,双侧分别给予浓度为0.5%的罗哌卡因注射液10 m L;LA组患者实施局部多点麻醉,给予浓度为0.5%的罗哌卡因注射液共20 m L。分别观察比较两组的首次疼痛时间及术后视觉模拟评分,曲马多需求量情况、肛门括约肌痉挛情况、术后恶心呕吐情况及患者满意度情况。结果 PNB组肛门疼痛评分在术后12 h内各点明显低于LA组(Z=-5.909,P<0.001)。且PNB组较LA组第一次感到肛门痛时间延后(t=10.502,P<0.0001)、术后对曲马多的使用量趋势降低(Χ~2=4.022,P<0.05),肛门括约肌痉挛情况减少(Χ~2=2.390,P<0.05),患者对该方法的满意程度增加(Χ~2=8.531,P<0.05),而患者PONV情况则差异无统计学意义(Χ~2=0,P>0.05)。结论混合痔外剥内扎切除术后使用阴部神经阻滞镇痛短期效果良好,尿潴留发生率明显降低。

Objective The aim of this randomized and double-blind study was to introduce and examine the clinical utility of an improved ultrasound-guided pudendal nerve block technique, and compare the effective of two different postoperative analgesia techniques, local infiltration analgesia and pudendal nerve block for PPH operation. Methods A total of 60 patients with mixed hemorrhoid were divided into ultrasound-guided pudendal nerve block group（Group PNB） and local infiltration analgesia group（Group LA） with 30 patients each. Group PNB received ultrasound-guided PNB after the surgery： 0.5% ropivacaine 10 m L each side and 0.5% ropivacaine 20 m L for Group LA. The postoperative analgesia effect measured by Median VAS pain scores. The Analgesia requirements, nausea and vomiting, spasm of anal sphincter during the first 48 postoperative hours and the satisfaction of the patients were also recorded. Ultrasound-guided assessment was confirmed by the anatomical structure and the local anesthetic expanding. Result There was a significant reduction in the analgesia duration and the tramadol consumption in Group PNB compared with Group LA. The median VAS within the first 12 hours in PNB group was much lower（Z=-5.909, P 0.001）. The spasm of anal sphincter in Group PNB was less than Group LA in 48 hours after operation（t=10.502, P 0.0001）; the satisfaction of the patients was higher in Group PNB（Χ~2=8.531,P 0.05）. ConclusionUltrasound-guided PNB could provide good postoperative analgesia for PPH, and decrease the rate of urinary retention.