乳腺癌改良根治术麻醉的优化策略:混合药物单次胸椎旁神经阻滞联合全麻

Optimized strategy of anesthesia for modified radical mastectomy for breast cancer: single-injection thoracic paravertebral block with multiple adjuvants combined with general anesthesia

目的评价混合药物单次胸椎旁神经阻滞(TPVB)联合全麻用于乳腺癌改良根治术麻醉的优化效应。方法择期全麻下行初次乳腺癌改良根治术病人60例,年龄20~60岁,BMI<30 kg/m2,ASA分级Ⅰ或Ⅱ级。采用随机数字表法分为2组(n=30):混合药物单次TPVB组(PV-SI组)麻醉诱导后0.25%罗哌卡因25 ml、地塞米松3 mg、丁丙诺啡120μg和肾上腺素2.5μg/ml单次TPVB联合全麻;持续输注TPVB组(PV-CI组)麻醉诱导后0.25%罗哌卡因25 ml和肾上腺素2.5μg/ml混合液单次注射后持续输注0.125%罗哌卡因8 ml/h至术后48 h。手术结束时连接病人自控静脉镇痛泵,单次按压吗啡剂量2 mg,锁定时间10 min,无负荷剂量及背景输注。记录术后镇痛持续时间、术后48 h内吗啡总消耗量、恶心呕吐发生情况、病人推荐及满意情况。结果与PV-CI组比较,PV-SI组术后镇痛持续时间、术后48 h内吗啡总消耗量、恶心呕吐发生率、病人推荐率及满意率差异无统计学意义(P>0.05)。结论混合药物单次TPVB联合全麻可作为有助于改善乳腺癌改良根治术病人术后镇痛效果的优化策略。

Objective To evaluate the optimized efficacy of single-injection thoracic paravertebral block(TPVB)with multiple adjuvant drugs combined with general anesthesia for modified radical mastectomy(MRM)for breast cancer.Methods Sixty American Society of Anesthesiologists physical statusⅠorⅡpatients,aged 20-60 yr,with body mass index<30 kg/m2,scheduled for elective primary modified radical mastectomy for breast cancer under general anesthesia,were divided into 2 groups(n=30 each)using a random number table method:single-injection TPVB with multiple adjuvants group(group PV-SI)and continuous infusion via TPVB group(group PV-CI).In group PV-SI,single-injection TPVB was performed with 0.25%ropivacaine 25 ml,dexamethasone 3 mg,buprenorphine 120μg,and adrenaline 2.5μg/ml,and general anesthesia was performed after induction of anesthesia.In group PV-CI,the mixture of 0.25%ropivacaine 25 ml and epinephrine 2.5μg/ml was injected after induction of anesthesia,and then 0.125%ropivacaine 8 ml/h was continuously infused via TPVB until 48 h after operation.At the end of operation,a patient-controlled intravenous analgesic pump was connected and programmed to deliver a bolus dose of morphine 2 mg with a lockout interval of 10 min and no loading dose and background infusion.The duration of postoperative analgesia,total consumption of morphine within 48 h after operation,occurrence of nausea and vomiting,and patient′s recommendation and satisfaction were recorded.Results There was no significant difference in the duration of postoperative analgesia,total consumption of morphine within 48 h after operation,incidence of nausea and vomiting,and rates of patient′s recommendation and satisfaction between PV-SI group and PV-CI group(P>0.05).Conclusion Single-injection TPVB with multiple adjuvants combined with general anesthesia can be used as an optimized strategy to improve the postoperative analgesia in the patients undergoing MRM for breast cancer.