乳腺纤维腺瘤切除术超声引导下局部麻醉的临床应用观察

Clinical application of ultrasound-guided local anesthesia for excision of breast fibroadenoma

目的探讨B超引导下局部麻醉在乳腺纤维腺瘤切除术中的效果及对术后镇痛的影响。方法乳腺纤维腺瘤病人50例,随机分为超声组和传统局麻组,每组各25例。超声组行B超引导下局部麻醉手术,传统局麻组采用传统局部麻醉手术。比较两组完成局部麻醉所需的皮肤穿刺针数、麻醉过程中的疼痛程度以及术后首次需要补救镇痛的时间。结果超声组完成局麻所需的皮肤穿刺数中位数为1针,传统局麻组中位数为3针,两组比较差异有统计学意义(P<0.05);超声组相比传统局麻组麻醉操作相关疼痛更轻;疼痛语言评价量表VRS评分分别为2分和4分,两组比较差异有统计学意义(P<0.05)。超声组首次需要补救镇痛的时间为(18.5±3.6)小时,传统局麻组为(4.2±1.3)小时,两组比较差异有统计学意义(P<0.05)。结论在乳腺纤维腺瘤切除术中,超声引导下局部麻醉与传统常规麻醉比较,局部麻醉产生更少的操作相关疼痛,并能提供更长的镇痛时间。

Objective To investigate the effect of local anesthesia guided by B ultrasound in breast fibroadenoma excision and its effect on postoperative analgesia. Methods 50 cases of breast fibro- adenoma were randomly divided into ultrasound group and traditional local anesthesia group. 25 cases in each group were operated by B-ultrasound guided local anesthesia, and traditional local anesthesia group was treated with traditional local anesthesia. The number of skin puncture needles required for local anes- thesia, pain during anesthesia, and the time needed for first postoperative analgesia were compared between the two groups. Results The median 1 needles required by the ultrasound group to complete local anes- thesia were less than the median 3 needles （ P 〈 0.05 ） in the traditional local anesthesia group （ P 〈 0.05 ）, and the pain in the ultrasound group was lighter than the traditional local anesthesia group （VRS score 2 vs 4 points, P 〈 0.05 ）. The time needed for remedial analgesia for the first time was significantly longer in the ultrasound group[ （18.5 ±3.6）h] than in the traditional local anesthesia group[ （4.2 ±1.3 ） h ] （P 〈 0.05 ）. Conclusion In breast fibroadenoma resection, ultrasound guided local anaesthesia produces less produce-related pain than traditional blind puncture local anaesthesia, and can provide lon- ger analgesia time.