胸神经联合胸横肌平面阻滞用于乳腺癌根治术后镇痛的效果观察

Analgesic effect of pectoral nerve block combined with transversus thoracic muscle plane block in patients undergoing radical mastectomy

目的探讨胸神经联合胸横肌平面阻滞用于乳腺癌根治术后疼痛的效果。方法选择择期行乳腺癌根治术的女性患者60例,按随机数字表法分为胸神经联合胸横肌平面阻滞复合静脉自控镇痛(PCIA)组(研究组)和单纯PCIA组(对照组),每组30例。研究组于麻醉诱导后在超声引导下实施胸神经联合胸横肌平面阻滞;对照组仅采用全凭静脉全麻。两组患者术毕进行PCIA。观察患者术后2h(T1)、4h(T2)、8h(T3)、12h(T4)、24h(T5)的静态和动态视觉模拟评分(VAS),并详细记录24h内镇痛泵按压次数和补救镇痛病例数及相关不良反应发生情况。结果研究组T1~T4时点静态VAS评分和T1~T5时点动态VAS评分均低于对照组(均P<0.05)。与对照组比较,研究组术后0~12h补救镇痛率和镇痛泵按压次数降低,恶心、呕吐等不良反应发生率均明显下降(均P<0.05)。两组患者术后12~24h的补救镇痛和镇痛泵按压次数比较差异均无统计学意义(均P>0.05)。结论胸神经联合胸横肌平面阻滞复合PCIA能有效提高乳腺癌根治术后镇痛的效果,对乳腺癌患者术后的急性疼痛有预防作用。

Objective To assess the effect of pectoral nerves blocks combined with transversus thoracic muscle plane block in patients undergoing radical mastectomy.Methods Sixty patients aged 45~70 yr of ASA I orⅡscheduled for radical mastectomy,were randomly assigned in study group and control group with 30 in each group.Patient-controlled intravenous analgesia(PCIA)was given after surgery in both groups.In study group the ultrasound-guided pectoral nerves block combined with transversus thoracic muscle plane block was performed after general anesthesia induction,while in control group patients received PCIA only.Pain at rest and during movement was assessed using VAS score at 2h(T1),4h(T2),8h(T3),12h(T4)and 24h(T5)after surgery.The numbers of PCA pressings and cases of remedial analgesia within 24h after operation and side effects were recorded.Results In study group,the VAS scores at rest(T1~T4)and during movement(T1~T5)were significantly lower than those in control group(P<0.05).Compared with control group,the numbers of PCA pressings and cases of remedial analgesia within 0~12h after operation in study group were reduced(P<0.05),and the incidence of nausea and vomiting was significantly lower in study group than that in control group(P<0.05).There was no significant difference in the numbers of PCA pressings and cases of remedial analgesia at 12h and 24h postoperatively between the two groups(P>0.05).Conclusion The combination of pectoral nerves block and transversus thoracic muscle plane block is effective in reducing pain after radical mastectomy patients and produces good analgesia for radical breast surgery.