超声引导耳大神经阻滞联合全麻用于成年患者中耳显微手术的效果

Efficacy of ultrasound-guided great auricular nerve block combined with general anesthesia for mid-die ear microsurgery in adult patients

目的评价超声引导耳大神经阻滞联合全麻用于成年患者中耳显微手术的效果。方法择期中耳显微外科手术患者64例，ASA分级I或Ⅱ级，性别不限，年龄18～60岁，采用随机数字表法分为2组（n=32）：耳大神经阻滞联合全麻组（GANB＋G组）和全麻组（G组）。GANB＋G组全麻诱导前应用超声引导平面内技术以0．25％罗哌卡因2ml阻滞患侧耳大神经。2组全麻诱导与维持方案相同（静脉输注异丙酚复合TC[瑞芬太尼）。术后采用舒芬太尼、氟比洛芬酯或帕瑞昔布钠进行补充镇痛。以维持术后48h内VAS评分〈4分。记录丙泊酚与瑞芬太尼的输注时间及用量、术后镇痛情况以及术后恶心呕吐发生情况。结果与G组比较，GANB＋G组瑞芬太尼用量减少，术后镇痛率和恶心呕吐发生率降低（P〈0．05或0．01）。结论超声引导耳大神经阻滞联合全麻用于成年患者中耳显微手术可提供良好的围术期镇痛效果。

Objective To evaluate the efficacy of ultrasound-guided great auricular nerve （GAN） block combined with general anesthesia for middle ear microsurgery in adult patients. Methods Sixty-four adult patients of both sexes, aged 18-60 yr, of American Society of Anesthesiologists physical status I or I[ , scheduled for elective middle ear microsurgery, were assigned into 2 groups （ n = 32 each） using a random number table： GAN block combined with general anesthesia group （group GANB＋G） and general anesthesia group （group G）. Patients received GAN block with O. 25% ropivacaine 2 ml using ultrasoundguided in-plane technique before anesthesia induction in group GANB＋G. Anesthesia induction and maintenance protoeols（ IV infusion of propofol and target controlled infusion of remifentanil） were similar in two groups. Analgesia was performed with sufentanil, flurbiprofen axetil or parecoxib sodium after operation to maintain visual analog scale score 〈4 within 48 h after operation. The infusion duration and consumption of propofol and remifentanil, requirement for postoperative analgesia and occurrence of postoperative nausea and vomiting were recorded. Results Compared with group G, the consumption of remifentanil was signif- icantly reduced, and the requirement for postoperative analgesia and incidence of postoperative nausea and vomiting were decreased in group GANB ＋ G （ P 〈 0. 05 or 0.01 ）. Conclusion Ultrasound-guided GAN block combined with general anesthesia provides better analgesic efficacy in the the perioperative period in a- dult patients undergoing middle ear microsurgery.