罗哌卡因头皮神经阻滞对脑膜瘤切除术患者术后康复质量的影响

Effect of ropivacaine scalp nerve block on the quality of recovery after meningioma resection

目的探讨罗哌卡因行头皮神经阻滞对脑膜瘤切除术后患者康复质量的影响。方法择期全身麻醉下行脑膜瘤切除术患者122例,男29例,女93例,年龄28~74岁,BMI 18~28 kg/m^2,ASAⅠ或Ⅱ级,随机分为两组:罗哌卡因头皮神经阻滞组(R组,n=64)和生理盐水对照组(S组,n=58)。R组的患者在全麻诱导后头架安装前15 min以0.5%罗哌卡因15~20 ml行眶上、滑车上、耳颞、枕大和枕小神经阻滞,S组用等量生理盐水予以注射。两组均行气管插管全身麻醉。记录术中麻醉药物;术前、术后第3天和出院前患者KPS评分;术后第1、2、3天VAS疼痛评分;麻醉满意度,术后3d帕瑞昔布钠使用总量,住院时间。结果与S组比较,R组术中丙泊酚、瑞芬太尼、顺式阿曲库铵用量明显减少(P<0.05)。与术前比较,术后第3天两组KPS评分明显降低(P<0.05),出院前两组KPS评分明显升高(P<0.05);术后第3天R组KPS评分明显高于S组(P<0.05)。术后第1、2、3天R组VAS疼痛评分均明显低于S组(P<0.05)。R组麻醉满意度评分明显高于S组(P<0.05)。术后3 d内R组帕瑞昔布钠使用率明显低于S组(P<0.05)。两组住院时间差异无统计学意义。结论罗哌卡因头皮神经阻滞能提高患者麻醉满意度评分,降低患者术后疼痛,对患者术后早期康复质量有一定改善作用。

Objective To explore the effect of ropivacaine scalp nerve block on the quality of rehabilitation in patients undergoing meningioma resection.Methods A total of 122 patients scheduled for meningioma resection undergoing general anesthesia,29 males and 93 females,aged 28-74 years,BMI 18-28 kg/m^2,ASA physical statusⅠorⅡ,were randomly divided into ropivacaine scalp nerve block group(group R,n=64)and normal saline control group(group S,n=58).In group R,supraorbital,supra-spindle,auricular,greater occipital,and lesser occipital nerve blocks were performed with 15-20 ml of 0.5%ropivacaine after induction of anesthesia and 15 min before erection of head rack.In group S,equal amount of normal saline was injected.General anesthesia were used in both groups.the amount of anesthetic during the surgery,KPS score before and the third day after surgery and at discharge,Visual Analogue Scale(VAS)at 1st,2nd and 3rd d after surgery,satisfaction of anesthesia,total amount of parecoxib sodium used 3 d after surgery,Length of hospital stay were recorded.Results Compared with group S,the amount of propofol,remifentanil and cisatracurium in group R was significantly reduced(P<0.05).Compared with the preoperative,the KPS scores of the two groups were significantly reduced at the 3rd d after surgery(P<0.05),and the KPS scores of the two groups were significantly increased before the discharge(P<0.05);At the 3rd d after surgery,the KPS score of group R was significantly higher than that of group S(P<0.05).The VAS pain scores of group R were significantly lower than those of group S at 1st,2nd and 3rd d after surgery(P<0.05).Satisfaction of anesthesia in group R was significantly higher than that in group S.The use of parecoxib sodium in group R was significantly lower than that in group S within 3 d after surgery(P<0.05).There was no statistically difference in length of stay between the two groups.Conclusion The scalp nerve block can improve the patient’s score of anesthesia satisfaction,reduce the patient’s postoperative pain,and improve the quality of short-term postoperative recovery.