超声引导下右侧膈神经阻滞对腹腔镜全子宫切除术后患者肩痛的预防效果

Efficacy of ultrasound-guided right phrenic nerve block in preventing shoulder pain after total laparoscopic hysterectomy

目的探讨超声引导下右侧膈神经阻滞对腹腔镜全子宫切除术后患者肩痛的影响。方法择期行全麻腹腔镜全子宫切除术患者160例,年龄45~65岁,体重50~80 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为2组(n=80):对照组(C组)和右侧膈神经阻滞组(R组)。R组麻醉诱导前行右侧膈神经阻滞:注入0.375%罗哌卡因6 ml。2组均采用气管插管全凭静脉麻醉。采用VAS评分评价术后肩痛程度,VAS评分≥4分时,给予酮咯酸氨丁三醇30 mg。记录术后72 h内肩痛发生情况和镇痛药物用量。结果与C组比较,R组术后肩痛发生率和镇痛药用量降低(P<0.05)。结论超声引导下右侧膈神经阻滞可预防腹腔镜全子宫切除术后肩痛。

Objective To investigate the efficacy of ultrasound-guided right phrenic nerve block in preventing shoulder pain after total laparoscopic hysterectomy.Methods A total of 160 patients,aged 45-65,weighing 50-80 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective total laparoscopic hysterectomy,were divided into 2 groups(n=80 each)using the random number table method:control group(group C)and right phrenic nerve block group(R group).The right phrenic nerve blockade was performed before induction of anesthesia,and 0.375% ropivacaine 6 ml was injected in R group.Tracheal intubation was used for total intravenous anesthesia in two groups.The severity of postoperative shoulder pain was assessed using visual analogue scale score.When visual analogue scale score≥4,ketorolac tromethamine 30 mg was given.The development of shoulder pain and consumption of analgesics within 72 h after operation were recorded.Results Compared with group C,the incidence of postoperative shoulder pain and consumption of analgesics were significantly decreased in group R(P<0.05).Conclusion Ultrasound-guided right phrenic nerve block can prevent shoulder pain after total laparoscopic hysterectomy.