超声引导下前锯肌平面阻滞与胸椎旁神经阻滞在乳腺癌术后镇痛的比较

Comparison of Postoperative Analgesia Effect between Ultrasound-guided Serratus Plane Block and Thoracic Paravertebral Nerve Block Undergoing Radical Mastectomy

目的:比较超声引导下前锯肌平面阻滞和胸椎旁神经阻滞在乳腺癌术后的镇痛效果。方法:选择择期行乳腺癌根治术患者60例,年龄30~65岁,ASAⅠ或Ⅱ级。随机分为前锯肌平面阻滞联合术后静脉自控镇痛组(S组)、胸椎旁神经阻滞联合术后静脉自控镇痛组(T组),每组30例。两组神经阻滞局麻药均为0.33%罗哌卡因20 ml。S组与T组分别于超声引导下神经阻滞后诱导。分别记录术后2、6、12、24 h VAS疼痛评分;记录术后24 h自控静脉镇痛泵按压次数及术中镇痛药的用量;记录阻滞相关不良反应。结果:与T组比较,S组术后12、24 h VAS疼痛评分较高(P<0.05);S组与T组术后24 h自控静脉镇痛泵按压次数及镇痛药使用总量比较差异无统计学意义(P>0.05)。两组患者术后恶心呕吐发生率比较,差异无统计学意义(P>0.05)。结论:超声引导下前锯肌平面阻滞与超声引导下胸椎旁神经阻滞均可为乳腺癌患者提供术后良好的镇痛,加速患者的康复,但胸椎旁神经阻滞镇痛持续时间更久,镇痛效果更好。

Objective:To compare the analgesic effect between ultrasound-guided serratus plane block and thoracic paravertebral nerve block undergoing radical mastectomy.Method:Sixty ASAⅠor Ⅱ patients,aged 30~65 years,undergoing radical mastectomy were randomly divided into group S and T,30 cases in each group.0.33% ropivacaine 20 ml were used in the two groups.The ultrasound-guided never block after induced in group S and group T.VAS pain scores were recorded at 2,6,12 h and 24 h after surgery.The times of analgesic pump and the amount of analgesics used during operation were recorded.Block related adverse reactions and complications of puncture were recorded.Result:Compared with group T,VAS pain scores of group S were higher at 12 h and 24 h after operation (P<0.05).There was no statistical significance in the times of analgesic pump and the amount of analgesics used during operation between group S and group T (P>0.05).There was no significant difference in complications of nausea and vomiting of two groups (P>0.05).Conclusion:Ultrasound-guided serratus plane block and thoracic paravertebral nerve block can provide good postoperative analgesia for patients undergoing radical mastectomy.However,thoracic paravertebral nerve block is more better.