超声引导下胸椎旁神经阻滞与胸神经Ⅱ阻滞对乳腺癌根治术后镇痛的效果比较

Comparison on effects between ultrasound-guided thoracic paravertebral nerve block and thoracic nerve block for postoperative analgesia after radical mastectomy

目的比较超声引导下胸椎旁神经(TPVN)阻滞与胸神经Ⅱ(Pecs Ⅱ)阻滞对乳腺癌根治术后的镇痛效果。方法选择2016年9月至2017年9月在安阳市中医院行乳腺癌根治术的患者85例,按随机数字表法将其分为TPVN(42例)和PecsⅡ组(43)例。TPVN组在超声引导下进行TPVN阻滞,麻醉药物采用25 ml罗哌卡因,浓度为0.5%;Pecs Ⅱ组在超声引导下进行Pecs Ⅱ阻滞,麻醉药物、浓度与剂量与TPVN组相同。所有患者在术后采用经静脉患者自控镇痛(PCIA)。比较两组术后疼痛、镇痛时间及舒芬太尼使用情况,并比较两组胸椎节段痛觉减退情况。结果Pecs Ⅱ组术后1、5、8 h视觉模拟量表(VAS)评分及术后24 h舒芬太尼用量均低于TPVN组(P<0.05);Pecs Ⅱ组术后镇痛时间及阻滞皮区到达第2胸椎(T2)的比例高于TPVN组(P<0.05)。结论超声引导下Pecs Ⅱ阻滞应用于乳腺癌根治术中麻醉效果确切,可减轻患者的疼痛,延长镇痛时间。

Objective To compare the effects of ultrasound-guided thoracic paravertebral nerve (TPVN) block and thoracic nerve Ⅱ(Pecs Ⅱ) block on postoperative analgesia after radical mastectomy. Methods A total of 85 patients who underwent radical mastectomy in Anyang Hospital of Traditional Chinese Medicine were enrolled in this study. They were divided into TPVN group and Pecs Ⅱ group by random number table method. Among them, 42 patients in TPVN group underwent TPVN block under ultrasound guidance, and 25 ml ropivacaine was used for anesthesia with a concentration of 0.5%;43 patients in Pecs Ⅱ group underwent ultrasound-guided Pecs Ⅱ blockade, and were given ropivacaine at the same concentration and dosage as TPVN group for anesthesia. All patients underwent intravenous patient-controlled analgesia (PCIA) after surgery. The postoperative pain, analgesia time and the use of sufentanil were compared between the two groups, and the pain relief of the thoracic segments was compared between the two groups. Results The VAS scores of Pecs Ⅱ group at 1, 5, and 8 h after operation and the dose of sufentanil at 24 h after operation were lower than those of TPVN group (P<0.05). The postoperative analgesia time and the blockage of the T2 in Pecs Ⅱ group were higher than those in TPVN group (P<0.05). Conclusions Ultrasound-guided Pecs Ⅱ block is effective in radical mastectomy, which can reduce pain and improve analgesia time.