超声引导下胸横肌平面阻滞联合胸壁神经阻滞在乳腺癌改良根治术中的应用效果

Application effect of ultrasound-guided transversus thoracic muscle plane block combined with chest wall nerve block in modified radical mastectomy of breast cancer

目的探讨超声引导下胸横肌平面阻滞联合胸壁神经阻滞在乳腺癌改良根治术中的应用效果。方法将择期行乳腺癌改良根治术的80例患者随机分为胸横肌平面阻滞联合胸壁神经阻滞组(TP组)和胸壁神经阻滞组(P组),每组40例,术中两组患者在超声引导下行相应的神经阻滞进行镇痛。比较两组患者术后3 h、6 h、12 h、24 h、48 h的疼痛数字评价量表(NRS)评分、Ramsay镇静评分,以及术后48 h内的恶心呕吐发生率。记录两组患者术中瑞芬太尼和丙泊酚用量、术后镇痛药物使用情况、神经阻滞操作相关并发症发生情况。结果术后3 h、6 h、12 h、48 h,TP组患者的疼痛NRS评分均低于P组(均P<0.05),而两组患者术后各时间点的Ramsay镇静评分及术后48 h内的恶心呕吐发生率比较,差异均无统计学意义(均P>0.05)。两组患者均未发生局麻药物中毒、局部血肿、血胸及气胸等不良反应,TP组术中瑞芬太尼用量及术后镇痛药物使用率少于或低于P组(均P<0.05)。结论对于乳腺癌改良根治术患者,相较于单纯的胸壁神经阻滞,超声引导下胸横肌平面阻滞联合胸壁神经阻滞的围术期镇痛效果更好,术中瑞芬太尼和术后镇痛药物的用量更少,且安全性较高。

Objective To investigate the application effect of ultrasound-guided transversus thoracic muscle plane block combined with chest wall nerve block in modified radical mastectomy of breast cancer.Methods Eighty patients with breast cancer undergoing selective modified radical mastectomy were randomly divided into transversus thoracic muscle plane block combined with chest wall nerve block group(group TP)and chest wall nerve block group(group P),with 40 cases in each group.Patients in the two groups underwent corresponding ultrasound-guided nerve block during operation for analgesia.The Numerical Rating Scale(NRS)pain scores and Ramsay Sedation Scale scores three,six,12,24 and 48 hours after operation,as well as incidence rate of nausea and vomiting within 48 hours after operation,were compared between the two groups.The dosages of remifentanil and propofol during operation,utilization of postoperative analgesics,and incidence of complications related to nerve block operation were recorded in both groups.Results Three,six,12 and 48 hours after operation,group TP had lower NRS pain scores than group P(all P<0.05),whereas there was no statistically significant difference in Ramsay sedation score at any time point after operation or incidence rate of nausea and vomiting within 48 hours after operation between the two groups(all P>0.05).No adverse reactions occurred in the two groups,such as local anesthetic poisoning,local hematoma,hemothorax and pneumothorax.Group TP yielded a less dosage of intraoperative remifentanil and a lower rate of postoperative analgesics use as compared with group P(all P<0.05).Conclusion For patients with breast cancer undergoing modified radical mastectomy,compared with simple chest wall nerve block,ultrasound-guided transversus thoracic muscle plane block combined with chest wall nerve block has better perioperative analgesic effect,achieving decreased dosages of intraoperative remifentanil and postoperative analgesics and higher safety.