胸椎旁神经阻滞和肋间神经阻滞应用于乳腺肿物切除术的镇痛效果评价

Analgesic effect of thoracic paravertebral nerve block and intercostal nerve block in mastectomy

目的评价乳腺肿物切除术中不同麻醉方法的镇痛效果。方法选择武警陕西省总队医院2017年2月至2019年1月择期乳腺肿物切除术患者80例,按随机数表法分为观察组和对照组各40例,观察组采用肋间神经阻滞麻醉,对照组采用胸椎旁神经阻滞麻醉,比较两组患者的手术时间、术中芬太尼及丙泊酚使用量、首次镇痛时间、术后24 h舒芬太尼使用量以及术后2 h、4 h、6 h、12 h、24 h的视觉模拟评分(VAS)。结果两组患者的手术时间、术中芬太尼及丙泊酚使用量比较差异均无统计学意义(P>0.05);观察组患者的首次镇痛时间为(171.4±10.9)min,明显长于对照组的(108.3±21.2)min,术后24 h舒芬太尼用量为(50.9±11.2)μg,明显少于对照组的(69.2±9.2)μg,差异均有统计学意义(P<0.05);观察组患者术后4 h、6 h的VAS评分分别为(4.16±0.16)分、(3.96±0.13)分,明显低于对照组的(5.92±0.24)分、(5.52±0.25)分,差异均有统计学意义(P<0.05);两组患者术后2 h、12 h、24 h的VAS评分比较差异均无统计学意义(P>0.05)。结论乳腺肿物切除术选择肋间神经阻滞具有较好的镇痛效果,且可降低术后麻醉药物使用量,易被患者接受。

Objective To evaluate the analgesic effect of different anesthesia methods in breast tumor resection.Methods Eighty patients undergoing mastectomy in Shaanxi Provincial General Hospital of Armed Police between February 2017 and January 2019 were divided into the observation group(n=40)and the control group(n=40)according to the random number table.Patients in the observation group were given intercostal nerve block(INB),and those in the control group were given thoracic paravertebral nerve block(TPVB).Then operation time,intraoperative use of fentanyl and propofol,first analgesia time,24 h postoperative use of sufentanil,2 h,4 h,6 h,12 h,24 h VAS score,patients’satisfaction,complication rate were compared between the two groups.Results There was no significant difference in operation time,fentanyl,and propofol dosage between the two groups(P>0.05);the first analgesia time of the observation group was(171.4±10.9)min,significantly longer than(108.3±21.2)min in the control group,and 24 h postoperative use of sufentanil was(50.9±11.2)μg,significantly less than(69.2±9.2)μg in the control group(P<0.05);the VAS score of the observation group at 4 h and 6 h after operation was(4.16±0.16)points,(3.96±0.13)points,significantly lower than(5.92±0.24)points,(5.52±0.25)points in the control group(P<0.05).There was no significant difference in the VAS score of the two groups at 2 h,12 h and 24 h after operation(P>0.05).Conclusion Intercostal nerve block has a better analgesic effect in mastectomy,which can reduce the use of postoperative anesthetic drugs and is easy to be accepted by patients.