全身麻醉联合超声引导竖脊肌平面阻滞可有效减轻乳腺癌改良根治术患者术后疼痛

Effect of general anesthesia combined with ultrasound-guided erector spinal plane block on postoperative pain after modified radical mastectomy for breast cancer

目的评估全身麻醉联合超声引导竖脊肌平面阻滞(ESPB)在乳腺癌改良根治术患者术中和术后镇痛的效果。方法选取2021年5—8月莆田学院附属医院收治的行乳腺癌改良根治术患者50例,采用电脑随机数字表法以1∶1比例分为E组和C组,每组25例。E组采用全身麻醉联合超声引导ESPB,C组采用单纯全身麻醉。比较2组患者麻醉诱导前(T0)、麻醉诱导后5 min(T1)、手术切皮后5 min(T2)时的平均动脉压(MAP)、心率等,以及术中、术后阿片类药物用量,术后首次出现疼痛时间,术后静息状态视觉模拟疼痛量表评分等。结果E组患者T0、T1时MAP、心率与C组比较,差异均无统计学意义(P>0.05);T2时MAP、心率均明显低于C组,差异均有统计学意义(P<0.05)。E组患者术中、术后24 h阿片类药物用量均明显低于C组,术后出现第1次疼痛时间明显长于C组,术后3、6、12 h静息状态视觉模拟疼痛量表评分均明显低于C组,差异均有统计学意义(P<0.05)。结论超声引导ESPB联合全身麻醉可有效减轻乳腺癌改良根治术患者术中及术后疼痛,是一种相对安全的周围神经阻滞方法。

Objective To evaluate the efficacy of general anesthesia combined with ultrasound-guided erector spinal plane block(ESPB)for intraoperative and postoperative analgesia in modified radical mastectomy for breast cancer.Methods A total of 50 patients undergoing modified radical mastectomy for breast cancer in Affiliated Hospital of Putian College from May to August 2021 were selected and divided into the group E and group C in a 1∶1 ratio according to the computer random number table method.The group E received general anesthesia combined with ultrasonics-guided ESPB,and group C received general anesthesia alone.The levels of mean arterial pressure(MAP)and heart rate(HR)before induction of anesthesia(T0),five minutes after induction of anesthesia(T1),five minutes after surgical skin resection(T2)were measured.And the intraoperative opioid dosage,postoperative opioid dosage,the first pain time of postoperative,and postoperative visual analog scale(VAS)score were compared between the two groups.Results There were no statistical significances in MAP and HR between group E and group C in T0 and T1(P>0.05).The MAP and HR in T2 were significantly lower than those in group C(P<0.05).The intraoperative opioid dosage,postoperative opioid dosage at 24 h after surgery in group E were significantly lower than those in group C.The first pain time of postoperative in group E was longer than that in group C,and VAS scores at 3 h,6 h and 12 h after surgery in group E were significantly lower than those in group C(P<0.05).Conclusion Ultrasound-guided ESPB combined with general anesthesia can effectively reduce intraoperative and postoperative pain in patients undergoing modified radical mastectomy for breast cancer.Ultrasound-guided ESPB is a relatively safe peripheral nerve block method.