超声引导下外周神经联合阻滞在麻醉后恢复室中的应用

Application of ultrasound-guided peripheral nerve blocks in the post-anesthesia care unit

目的探讨超声引导下多重外周神经联合阻滞在PACU(麻醉后恢复室)中用于全麻下肢手术术后镇痛的有效性和可行性。方法选择本院2017年7-12月PACU单侧下肢全麻手术患者60例,随机分为地佐辛镇痛组(D组)和外周神经阻滞镇痛组(N组),每组30例。D组静脉注射地佐辛0.1 mg/kg。N组由同一名操作者根据手术部位镇痛需要,在超声引导下实施神经阻滞,局麻药采用0.375%罗哌卡因。结果与D组比较,N组术后30 min、60 min、4 h、12 h静息和运动VAS评分均明显降低(P<0.05)。D组和N组PACU停留时间[(52.7±3.4) min vs.(50.0±4.2) min]、PACU内地佐辛的用量[(2.9±3.6) mg vs.(0.7±2.1) mg]、追加例数(12例vs.3例)和术后24 h病房内使用镇痛药的例数(17例vs.4例)比较差异均有统计学意义(P<0.05)。D组术后24 h出现恶心4例、呕吐3例,嗜睡7例,N组均未发生,两组比较差异有统计学意义(P<0.05)。D组和N组术后24 h总体满意度中满意率(23.3%vs.50%)和一般满意率(26.7%vs.3.3%)比较差异有统计学意义(P<0.05)。结论在PACU中利用超声引导下外周神经阻滞对全麻下肢手术患者实施术后镇痛是有效和可行的。外周神经阻滞可以提供较好的术后镇痛,缩短PACU停留时间,降低术后镇痛药使用量,不良反应少,总体满意度较高。

Objective To discuss the postoperative analgesic effect and safety of ultrasound-guided peripheral nerve blocks in unilateral lower extremity surgery in PACU(post-anesthesia care unit).Methods Sixty patients undergoing unilateral lower extremity surgery from July to December in 2017 in PACU of our hospital were randomly divided into dezocine group(group D)and peripheral nerve block group(group N),30 cases in each group.Group D received intravenous dezocine 0.1 mg/kg;group N underwent ultrasound-guided peripheral nerve blocks with 0.375%ropivacaine hydrochloride injection.Results VAS scores of rest and movement at 30 min,60 min,4 h and 12 h after surgery in group N were lower than those in group D(P<0.05).There were significant differences in the time of PACU stay[(52.7±3.4)min vs.(50.0±4.2)min],dosage of dezocine in PACU[(2.9±3.6)mg vs.(0.7±2.1)mg],the number of patients who were added analgesic(12 vs.3),and the number of patients who used analgesics in the ward within 24 h after surgery(17 vs.4)between group D and group N(P<0.05).In group D,the number of patients having nausea,vomiting and somnolence within 24 h after surgery was 4,3 and 7,respectively,while no such case occurred in group N.There were significant differences in the rates of satisfaction(23.3%vs.50%)and general satisfaction(26.7%vs.3.3%)between group D and group N at 24 h after operation(P<0.05).Conclusion Ultrasound-guided peripheral nerve blocks in PACU is feasible for unilateral lower extremity surgery.The peripheral nerve blocks has good analgesic effect,shortening the time of PACU stay,reducing the dosage of analgesic and the adverse reactions.Additionally,it improves the patients′satisfaction.