超声引导下后路与中路肋间神经阻滞用于腹腔镜胆囊切除术麻醉效果比较

Comparison of ultrasound-guided intercostal nerve block through posterior approach and middle approach in patients for laparoscopic cholecystectomy

目的比较超声引导下后路与中路肋间神经阻滞用于腹腔镜胆囊切除术麻醉效果。方法以2017年7月至2019年6月在嘉兴市第一医院择期行腹腔镜胆囊切除术的90例患者为研究对象,按随机数字表法分为3组,即超声引导下后路肋间神经阻滞联合全麻组(后路阻滞组)、中路肋间神经阻滞联合全麻组(中路阻滞组)、单纯全麻组,每组30例。比较3组患者围术期(入院时及术后4、8、12、24 h)无创平均血压、手术情况(手术时间、输液量、出血量)、术后(4、8、12、24 h)静息痛及活动痛视觉模拟量表(VAS)评分、术后肛门排气时间及加用镇痛药情况、不良反应发生情况。结果3组患者围术期同一时点无创平均血压比较,差异均无统计学意义(均P>0.05)。3组患者手术时间、输液量及出血量比较,差异均无统计学意义(均P>0.05)。3组患者术后同一时点静息痛及活动痛VAS评分比较,差异均有统计学意义(均P<0.05),其中后路阻滞组、中路阻滞组明显低于单纯全麻组(均P<0.05),后路阻滞组又明显低于中路阻滞组(均P<0.05)。3组患者术后均未发生局麻药中毒、穿刺部位感染血肿、呼吸抑制,但头晕、恶心、呕吐、皮肤瘙痒发生率以及加用镇痛药比例、肛门排气时间比较,差异均有统计学意义(均P<0.05)。结论相比于中路肋间神经阻滞,超声引导下后路肋间神经阻滞用于腹腔镜胆囊切除术后的镇痛效果更好,且术后肛门恢复排气时间较短。

Objective To compare the anesthesia efficiency of ultrasound-guided intercostal nerve block between the posterior approach and middle approach in patients for laparoscopic cholecystectomy.Methods Ninety patients scheduled to undergo laparoscopic cholecystectomy were enrolled into this study.They were randomized into three groups with 30 patients in each group:patients in group A received ultrasound-guided posterior approach intercostal nerve block combined with general anesthesia,patients in group B received ultrasound-guided middle approach intercostal nerve block combined with general anesthesia,and patients in group C received general anesthesia alone.The mean perioperative blood pressure(at admission,and at 4,8,12,24 h after surgery),operative time,volumes of fluid infusion and blood loss,and the visual analog scale(VAS)pain scores at resting and at 4,8,12,24 h after surgery were compared among three groups.The postoperative anal exhaust time,additional analgesics after surgery,and the incidence of adverse reactions were also compared among three groups.Results There was no significant difference in mean perioperative blood pressure at all time points among three groups(all P>0.05).There was no significant difference in operative time,fluid infusion volume and blood loss volume among three groups(all P>0.05).There were significant differences in VAS scores of resting pain and active pain at all time point after surgery among three groups(all P<0.05).The VAS scores in group A and B were significantly lower than those in group C(all P<0.05),and the VAS scores in group A were significantly lower than those in group B(all P<0.05).No complications including local anesthetic intoxication,local infection,hematoma,and respiratory depression were found among three groups,but there were significant differences in the incidence of postoperative dizziness,nausea,vomiting,pruritus,the proportion of additional analgesics and the postoperative anal exhaust recovery time among three groups(all P<0.05).Conclusion The posterior approach intercostal nerve block can provide better analgesic effect for laparoscopic cholecystectomy than the middle approach.