超声引导前锯肌平面阻滞与胸神经Ⅱ型阻滞用于全麻乳腺癌改良根治术患者围术期镇痛效果的比较

Efficacy of ultrasound-guided serratus plane block versus PecsⅡblock for perioperative analgesia in patients undergoing modified radical mastectomy for breast cancer under general anesthesia

目的比较超声引导下前锯肌平面阻滞和胸神经Ⅱ型(PecsⅡ)阻滞用于全麻乳腺癌改良根治术患者围术期镇痛效果。方法选择乳腺癌改良根治术女性患者60例,年龄20~60岁,ASA分级Ⅰ或Ⅱ级,采用计算机随机分组法将患者分为2组(n=30):前锯肌平面阻滞组(S组)和PecsⅡ阻滞组(P组)。2组均于全麻诱导前行超声引导下神经阻滞,阻滞药物均为0.5%罗哌卡因20 ml。术后均行舒芬太尼PCIA。采用肌肉注射曲马多100 mg进行补救镇痛。记录各节段皮区阻滞情况、术中瑞芬太尼和术后24 h内镇痛药(PCIA中舒芬太尼以及补救镇痛药)用量、神经阻滞时间、Horner综合征以及术后24 h内呼吸抑制、恶心呕吐等并发症的发生情况。结果与S组比较,P组T_(5)-T_(7)皮区阻滞率降低,术后舒芬太尼用量减少(P<0.01),术中瑞芬太尼用量和神经阻滞时间差异无统计学意义(P>0.05)。2组均未使用补救镇痛药,未见神经阻滞相关并发症及术后并发症发生。结论超声引导PecsⅡ阻滞用于乳腺癌改良根治术患者术后镇痛的效果优于前锯肌平面阻滞。

Objective To compare the perioperative analgesic efficacy of ultrasound-guided serratus plane block(SPB)with pectoral nervesⅡ(PecsⅡ)block in patients undergoing modified radical mastectomy for breast cancer under general anesthesia.Methods Sixty female patients,aged 20-60 yr,of American Society of Anesthesiologists physical statusⅠorⅡ,scheduled for modified radical mastectomy for breast cancer,were divided into 2 groups(n=30 each)using a random number table method:SPB group(group S)and PecsⅡblock group(group P).Both groups received ultrasound-guided nerve block with 0.5%ropivacaine 20 ml before induction of general anesthesia.The patients in both groups received patient-controlled intravenous analgesia.Tramadol 100 mg was intramuscularly injected as rescue analgesic.The block status of each segmental dermatome,comsumption of intraoperative remifentanil and analgesics(sufentanil in patient-controlled intravenous analgesia and rescue analgesics)within 24 h after operation,duration of nerve block,Horner syndrome,and complications such as respiratory depression,nausea and vomiting within 24 h after operation were also recorded.Results Compared with group S,the block rate of T_(5)-T_(7) dermatome and consumption of sufentanil after surgery were significantly decreased(P<0.01),and no significant change was found in the consumption of remifentanil and duration of nerve block in group P(P>0.05).No rescue analgesic was used and no nerve block-related complications and postoperative complications were found in either group.Conclusions The ultrasound-guided PecsⅡblock provides better efficacy than SPB in the patients undergoing modified radical mastectomy for breast cancer under general anesthesia.