超声引导下竖脊肌平面阻滞与胸椎旁神经阻滞用于乳腺癌根治术术后镇痛效果的比较

Comparison of Erector Spinae Plane Block and Thoracic Paravertebral Block Guided by Ultrasound on Postoperative Analgesia Effect after Radical Mastectomy

目的:比较超声引导下竖脊肌平面阻滞(ESPB)和胸椎旁神经阻滞(TPVB)用于乳腺癌根治术术后镇痛的效果。方法:2015年5月至2019年12月在山西医科大学第二医院接受乳腺癌根治术的64例患者,随机数字表法分为ESPB组和TPVB组,每组32例。在常规全身麻醉基础上,ESPB组行ESPB,TPVB组行TPVB,术后给予患者自控静脉镇痛(PCIA)。比较两组术后2、6、12、24、48 h静息与咳嗽时视觉模拟评分(VAS)评分;比较两组患者术后PCIA首次按压时间,术后24 h PCIA镇痛泵按压次数、PCIA舒芬太尼用量,补救镇痛以及不良反应的发生率。结果:两组患者术后各时间点静息和咳嗽时VAS评分间差异无统计学意义(P>0.05);两组患者术后PCIA首次按压时间、术后24 h PCIA舒芬太尼用量以及补救镇痛的发生率间差异无统计学意义(P>0.05);ESPB组患者术后24 h PCIA镇痛泵按压次数低于TPVB组,差异有统计学意义(P<0.05);ESPB组和TPVB组术后恶心呕吐、皮肤瘙痒、呼吸抑制和头晕的发生率显比较差异无统计学意义(P>0.05)。结论:超声引导下ESPB相较于TPVB用于乳腺癌根治患者术后镇痛效果相似,且不会增加不良反应的发生率,安全性较高,可替代TPVB为乳腺癌根治术患者提供良好的术后镇痛。

Objective: To compare the postoperative analgesia effect between erector spinae plane block(ESPB) and thoracic paravertebral block(TPVB) guided by ultrasound after radical mastectomy. Methods: From May 2015 to December 2019, 64 patients who underwent radical mastectomy in The Second Hospital of Shanxi Medical University were randomly divided into ESPB group and TPVB group, 32 cases in each group. On the basis of general anesthesia, ESPB group was given EspB, TPVB group was given TPVB,and patient-controlled intravenous analgesia(PCIA) was given after operation. The visual analogue scale(VAS) scores at rest and coughing at 2 h, 6 h, 12 h, 24 h and 48 h after operation were compared between the two groups. The first pressing time of PCIA, PCIA analgesia pump pressing times and dosage of PCIA sufentanil 24 h after operation, rescue analgesia and incidence of adverse reactions were compared between the two groups. Results: There was no significant difference in VAS scores between the two groups at rest and coughing at different time points after operation(P>0.05);There was no significant difference in first pressing time of PCIA, PCIA sufentanil 24 h after operation and the incidence of rescue analgesia between the two groups(P>0.05);The PCIA analgesia pump pressing times 24 h after operation in ESPB group were lower than those in TPVB group, the difference was statistically significant(P<0.05);There was no significant difference in the incidence of postoperative nausea and vomiting, skin itching,respiratory depression and dizziness between ESPB group and TPVB group(P>0.05). Conclusion: Compared with TPVB, ESPB guided by ultrasound has similar analgesic effect in patients with radical mastectomy, and it does not increase the incidence of adverse reactions. It has higher safety and can replace TPVB to provide good postoperative analgesia for patients with radical mastectomy.