椎板后阻滞对乳腺癌改良根治术病人术后镇痛效果的影响

Effect of retrolaminar block for postoperative analgesia in patients undergoing modified radical mastectomy

目的探讨椎板后阻滞(RLB)对乳腺癌改良根治术病人术后镇痛效果的影响。方法乳腺癌改良根治术病人50例,随机分为两组:椎板后阻滞组(RLB组)和对照组(C组)。RLB组病人在手术结束后行手术侧椎板后阻滞,注入0.5%罗哌卡因20 ml。两组术后均使用静脉自控镇痛(PCIA)。记录术后24小时内PCIA舒芬太尼总用量、有效按压次数及补救镇痛例数。记录术后2、4、6、12、24小时的静息视觉模拟评分(VAS)和Ramsay镇静评分及不良反应的发生情况。结果 RLB组术后24小时内PCIA舒芬太尼总用量和有效按压次数分别为(20±4)μg和(13±4)次,C组分别为(29±3)μg和(19±3)次,两组比较差异有统计学意义(P<0.05),两组补救镇痛率比较差异无统计学意义(P>0.05)。RLB组术后4、6、12小时的静息VAS评分分别为(1.9±0.5)、(2.1±0.5)和(1.9±0.7)分,C组分别为(2.6±0.6)、(2.5±0.5)和(2.3±0.5)分,两组比较差异有统计学意义(P<0.05),两组各时点Ramsay镇静评分比较差异无统计学意义(P>0.05)。RLB组术后恶心、呕吐发生率为16%,低于C组的44%,差异有统计学意义(P<0.05),两组术后头晕、皮肤瘙痒和呼吸抑制等发生率比较差异无统计学意义(P>0.05),RLB组未见阻滞相关并发症发生。结论椎板后阻滞能用于乳腺癌改良根治术,不仅可以减少术后阿片类药物用量,提高术后镇痛效果,还可以降低术后恶心、呕吐的发生率。

Objective To investigate the efficacy of retrolaminar block(RLB) for postoperative analgesia in patients undergoing modified radical mastectomy.Methods Fifty female patients,scheduled for modified radical mastectomy,were randomly divided into 2 groups(n=25 each):group RLB and control group(group C).Retrolaminar block were performed on the side of operation with 0.5% ropivacaine 20 ml in group RLB after surgery.All the patients received patient controlled intravenous analgesia(PCIA) with sufentanil after operation.The total consumption of sufentanil,the number of demand times and requirement for rescue analgesic within 24 h after surgery were recorded.Visual analogue scale(VAS) scores and Ramsay sedation scores were registered at 2,4,6,12,and 24 h after surgery.All adverse reactions were recorded.Results The amount of sufentanil consumed and the number of PCIA attempts in group RLB were(20±4) μg and(13±4) time,which were less than(29±3) μg and(19±3) time of group C after surgery(P<0.05).The VAS scores at rest in group RLB were(1.9±0.5),(2.1±0.5),(1.9±0.7) at 4,6,12 h after surgery,which were lower than(2.6±0.6),(2.5±0.5),(2.3±0.5) of group C(P<0.05).There were no significant difference in Ramsay sedation scores at different time points after operation(P>0.05).The incidence of nausea and vomiting in group RLB was 16%,which was lower than 44% of group C(P<0.05).The other adverse effects were no significant difference on two groups(P>0.05).RLB-related complications were not found in all patients.Conclusion Retrolaminar block is a safe and effective technique that reduces the postoperative opioid consumption and the occurrence of nausea and vomiting,enhances the efficacy of postoperative analgesia in patients undergoing modified radical mastectomy.