超声引导下胸神经阻滞技术应用于肩胛骨骨折手术的镇痛效果观察

Analgesic effects of ultrasound-guided thoracic nerve block on patients with scapular fracture

目的:探讨超声引导下胸神经阻滞技术对肩胛骨骨折手术患者的镇痛效果。方法:选取我院2018年1月至2019年11月间行肩胛骨骨折择期手术140例患者进行回顾性分析,共分为3组:气管插管全麻32例(G组),全麻联合臂丛阻滞55例(B组),全麻联合臂丛+胸神经阻滞53例(S组)。其中S组分为3个亚组:胸椎旁阻滞19例(S1组),竖脊肌阻滞16例(S2组),椎板阻滞18例(S3组)。分析术中舒芬太尼追加剂量、苏醒室内的视觉模拟评分法(visual analogue scale,VAS)疼痛评分和追加镇痛药物需求率。结果:在术中追加舒芬太尼用量、苏醒室中VAS评分和追加镇痛需求率方面,S组最低,B组和S组显著低于G组,差异具有统计学意义(P<0.05)。3个S亚组之间,差异无统计学意义。结论:肩胛骨骨折手术中,胸神经阻滞可以在全麻联合臂丛阻滞的基础上,进一步增强镇痛效果,3种胸神经阻滞技术镇痛效果相似。

Objective:To investigate the analgesic effects of ultrasound-guided thoracic nerve block on the patients with scapular fracture.Methods:140 patients underwent surgery for scapular fracture between January 2018 and November 2019 were retrospectively analyzed.Of these patients,32 received general anesthesia(group G),55 received brachial plexus block combined with general anesthesia(group B),and 53 received thoracic nerve and brachial plexus block combined with general anesthesia(group S).And the patients in group S were divided into three subgroups:19 received thoracic paravertebral block(subgroup S1),16 received erector spinae plane block(subgroup S2),and 18 received retrolaminar block(subgroup S3).The additional dosage of sufentanil,pain score,and the requirement of additional analgesics in the PACU were recorded and analyzed.Results:In terms of the additional dosage of sufentanil,pain score,and the requirement of additional analgesics,group B and group S were significantly lower than group G,and group S was also lower than group B(P<0.05).There was no statistical significance in the above assessments among the three subgroups.Conclusions:For the patients received brachial plexus block combined with general anesthesia,the additional thoracic nerve block can provide better analgesic effects.However,the effects of the three types of thoracic nerve block are similar.