超声引导胸膜横突中间点阻滞对腹腔镜根治性肾切除术患者围术期镇痛效果的观察

Perioperative analgesic efficacy of ultrasound-guided mid-point transverse process block in patient undergoing laparoscopic radical nephrectomy

目的探讨超声引导胸膜横突中间点(MTP)阻滞在腹腔镜根治性肾切除术围术期中镇痛的有效性及安全性。方法前瞻性随机对照研究。纳入2019年11月—2020年12月中国科学技术大学附属第一医院(安徽省立医院)限期行腹腔镜根治性肾切除的患者60例,其中男30例、女30例,年龄32~80(56.9±9.2)岁。60例患者按数字表法随机分为MTP阻滞组(MTP组)30例和静脉镇痛泵组(镇痛泵组)30例,其中MTP组采用全身麻醉联合超声引导MTP阻滞麻醉,镇痛泵组采用全身麻醉,2组患者术后均使用静脉镇痛泵48 h。比较2组患者手术时间、术中瑞芬太尼总用量,术后补救镇痛次数、镇痛泵有效按压次数、麻醉不良反应的发生情况、麻醉满意度评分,手术结束苏醒即刻(T1)及术后4 h(T2)、8 h(T3)、24 h(T4)患者静息疼痛视觉模拟评分法(VAS)评分。结果2组患者年龄、性别构成、体质量指数等基线资料比较,差异均无统计学意义(P值均>0.05)。2组患者均顺利完成麻醉和手术,MTP组无穿刺误伤胸膜及血管神经等并发症发生。2组患者手术时间、静脉镇痛补救次数比较,差异均无统计学意义(P值均>0.05)。MTP组术中瑞芬太尼使用量为(1.3±0.2)mg,低于镇痛泵组的(1.6±0.2)mg;MTP组镇痛泵有效按压次数(3.9±1.5)次,少于镇痛泵组的(8.2±1.7)次;麻醉满意度评分(4.5±1.0)分,高于镇痛泵组的(3.7±1.6)分:差异均有统计学意义(t=4.10、10.17、2.22,P值均<0.05)。MTP组在T1、T2时间点VAS评分[(2.8±0.9)分和(2.7±1.0)分]低于镇痛泵组[(3.3±1.0)分和(3.4±1.0)分],差异均有统计学意义(t=2.28、2.88,P值均<0.05),而T3、T4时间点VAS评分组间差异均无统计学意义(P值均>0.05)。2组患者的术后麻醉不良反应总发生率比较,MTP组为6.7%(2/30),低于镇痛泵组的30.0%(9/30),差异有统计学意义(χ^(2)=5.45,P=0.019)。结论超声引导MTP阻滞穿刺操作安全,并发症少,镇痛效果好,能减少围术期阿片类药物的使用,可以为腹腔镜根治性肾切除术提供安全、有效的镇痛。

Objective To investigate the efficacy and safety of ultrasound-guided mid-point transverse process(MTP)block in the perioperative analgesia of patient undergoing laparoscopic radical nephrectomy.Methods A prospective randomized control trial was conducted.Sixty patients who were scheduled for laparoscopic radical nephrectomy in The First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital)from November 2019 to December 2020 were included.The patients included 30 males and 30 females aged 32-80(56.9±9.2)years old and were randomly divided into two groups(MTP group and patient-controlled analgesia[PCA]group).Patients in the MTP group were given general anesthesia combined with ultrasound-guided MTP block.Patients were in the PCA group were only given general anesthesia.Corresponding PCA was linked in both groups after operation.Operative duration,remifentanil dosage,visual analogue scale(VAS)scores at different time(immediately after awake,T1;4 h after awake,T2;8 h after awake,T3;24 h after awake,T4),postoperative remedial analgesia,adverse reaction,and satisfaction score were recorded and compared.Results No significant differences in age,gender,body mass index,and other general information was found in both groups(all P values>0.05).Both groups of patients successfully completed surgery.No complications occurred in MTP group,such as accidental puncture to pleura,blood vessels and nerves.The remifentanil dosage in the MTP group([1.3±0.2]mg)was lower than that in the PCA group([1.6±0.2]mg).The effective times of PCA in the MTP group was also lower than that in the PCA group(3.9±1.5 vs 8.2±1.7).Satisfaction score was higher in the MTP group(4.5±1.0)than in the PCA group(3.7±1.6).Statistical differences in remifentanil dosage,effective time,and satisfaction score were found between the two groups(t=4.10,10.17,2.22;all P values<0.05).VAS scores at T1(2.8±0.9)and T2(2.7±1.0)in the MTP group were lower than those in the PCA group(3.3±1.0 and 3.4±1.0,respectively)with significant differences(t=2.28,2.88;all P values<0.05).However,VAS score was statistically non-significant at T3 and T4(all P values>0.05).The total incidence of postoperative adverse reactions in the MTP group was 6.7%(2/30),which was lower than that in the PCA group(30.0%[9/30])with significant difference(χ^(2)=5.45,P=0.019).Conclusion Ultrasound-guided MTP block is safe and effective and has few complications.It can provide a safe and effective analgesic method for laparoscopic radical nephrectomy by reducing the dosage of opioid analgesics.