超声引导下肋间神经阻滞复合全身麻醉对腹腔镜横结肠癌根治术后康复的影响

The effect of ultrasound-guided intercostal nerve block combined with general anesthesia on rehabilitation after laparoscopic radical resection of colon cancer

目的评价超声引导下肋间神经阻滞复合全身麻醉对腹腔镜横结肠癌根治术后康复的影响。方法40例患者以随机数字法分为肋间神经阻滞组I组与C组各20例。两组均在静吸复合全身麻醉下完成手术。麻醉诱导后手术切皮前实施超声引导下双侧胸8、胸9、胸10肋间神经阻滞,I组神经阻滞注射液为罗哌卡因75 mg、吗啡2 mg、地塞米松10 mg与生理盐水共20 ml,C组神经阻滞注射液为等量生理盐水。观察两组术中舒芬太尼、瑞芬太尼用量,及术后拔管时间、镇痛评分、术后第一次按压镇痛泵的时间、术后吗啡用量、术后相关并发症。结果与C组比较,I组术中舒芬太尼、瑞芬太尼及术后吗啡用量较小;术后24 h镇痛评分较低,术后第一次按压镇痛泵时较滞后;术毕拔管时间缩短,差异均有统计学意义(P<0.05);两组术后相关并发症发生率比较,差异无统计学意义(P>0.05)。结论超声引导下肋间神经阻滞复合全麻较单纯全麻显著减少术中术后阿片类药物用量,显著减少术后并发症,促进术后快速康复。

Objective To evaluate the effect of ultrasound-guided intercostal nerve block combined with general anesthesia on rehabilitation after laparoscopic radical resection of transverse colon cancer.Methods Forty patients were divided into an intercostal nerve block group(group I)and a control group(group C),20 in each group.Both groups were operated under intravenous inhalation combined with general anesthesia.After induction of anesthesia and before surgical skin incision,ultrasound-guided bilateral thoracic 8th,9th,and 10th thoracic intercostal nerve blocks were performed.In the group I,nerve block injection was ropivacaine 75 mg,morphine 2 mg,dexamethasone 10 mg and normal saline and the total amount was 20 ml,and the nerve block injection in the group C was the same amount of normal saline.The intraoperative dosage of sufentanil and remifentanil,and postoperative extubation time,analgesia score,time of the first postoperative analgesic pump compression,postoperative morphine dosage,and postoperative complications were observed in the two groups.Results Compared with the group C,the dosage of sufentanil,remifentanil,and morphine after operation in the group I was smaller.The analgesic score at 24 hours after operation was lower,and the first pressing of the analgesic pump after operation was delayed.The time to complete extubation was shortened The differences were statistically significant(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusion Ultrasound-guided intercostal nerve block combined with general anesthesia significantly reduces the intraoperative and postoperative opioid dosage.compared with simple general anesthesia.It also significantly reduces the postoperative complications,and promotes the rapid postoperative recovery.