单点注射法胸肌神经阻滞对乳腺癌改良根治术后镇痛效果的影响

Evaluation on analgesic effect of the single-injection technique of pectoral nerves Ⅰ and Ⅱ in patients undergoing modified radical mastectomy

目的探讨单点注射法胸肌神经(pectoral nerves,PECS)阻滞对乳腺癌改良根治术后镇痛效果的影响。方法选择择期全麻下行单侧乳腺癌改良根治术女性患者60例,年龄30～65岁,ASAⅠ或Ⅱ级,按随机数字表法分为两组:单点注射法PECS阻滞复合全麻组(P组)和单纯全麻组(C组),每组30例。全麻诱导完成后,P组患者在超声引导下实施术侧PECSⅠ和PECSⅡ阻滞,采用单点注射法,给予0.5%罗哌卡因30 ml;C组患者不给予PECS阻滞。两组在全凭静脉麻醉下完成手术。记录术中丙泊酚和瑞芬太尼用量、术后苏醒时间、术后48 h舒芬太尼总消耗量、镇痛泵首次按压时间、术后48 h补救性镇痛情况、镇痛泵按压次数。结果 P组术中丙泊酚用量和瑞芬太尼用量明显少于C组(P<0.05);术后苏醒时间明显短于C组(P<0.05);术后48 h舒芬太尼总消耗量明显少于C组(P<0.05);镇痛泵首次按压时间明显长于C组(P<0.05);术后48 h补救性镇痛率明显低于C组(P<0.05);术后24 h镇痛泵按压次数明显少于C组(P<0.05)。结论对于乳腺癌改良根治术患者,超声引导下单点注射法胸肌神经阻滞能减少围手术期阿片类药物用量,可以提供更佳的术后镇痛效果。

Objective To investigate the efficacy of the single-injection technique of PECSⅠandⅡblocks for postoperative analgesia in patients undergoing modified radical mastectomy.Methods Sixty female patients who would undergo elective unilateral modified radical mastectomy,aged 30-65 years,falling into ASA physical statusⅠorⅡ,were selected and randomly divided into PECS group(group P)or control group(group C),30 cases in each.After induction,patients in group P underwent ultrasound-guided combined PECSⅠandⅡblocks in a single-injection technique before surgery,30 ml of 0.5%ropivacaine was given to these patients.Patients in group C received general anesthesia alone.Anesthesia maintenance was performed by total intravenous anesthesia.The dosage of intraoperative propofol and remifentanil,postoperative recovery time,the requirement of sufentanil at 48 h after operation and the first time pressing the analgesic pump button,rescue analgesic requirements at 48 h after operation and the pressing frequency of analgesic pump were recorded in the two groups.Results The usage of propofol and remifentanil in group P were significantly less than those in group C(P<0.05).The recovery time after operation was significantly shorter than that in group C(P<0.05).The total consumption of sufentanil after 48 h was significantly less than that in group C(P<0.05).The first pressing time of the analgesic pump in group P was significantly later than that in group C(P<0.05).The rescue analgesic requirements in group P at 48 h were lower than those in group C(P<0.05).The pressing frequencies of analgesic pump in group P at 24 h were less than those in group C(P<0.05).Conclusion For patients undergoing modified radical mastectomy,ultrasound-guided combined PECSⅠandⅡblocks in a single-injection technique can reduce the dosage of opioid drugs in the perioperative period,and can provide better analgesic effect after operation.