超声引导下不同浓度罗哌卡因竖脊肌平面阻滞联合全身麻醉对腹腔镜全子宫切除术患者的麻醉效果和疼痛阈值的影响

Effect of different concentrations of ropivacaine erector spinae plane block combined with general anesthesia on anesthetic effect and pain threshold in patients undergoing laparoscopic total hysterectomy

目的探讨超声引导下不同浓度罗哌卡因竖脊肌平面阻滞联合全身麻醉对腹腔镜全子宫切除术患者的麻醉效果和疼痛阈值的影响。方法前瞻性选取2020年1月至2022年7月来宣城市中心医院择期行腹腔镜全子宫切除术的患者60例,按随机数字表法分为对照组,低、中、高剂量组,每组15例。对照组给予全身麻醉,低、中、高剂量组分别给予超声引导下0.15%、0.25%、0.33%罗哌卡因竖脊肌平面阻滞联合全身麻醉。比较4组患者术后2、4、8、24、48 h的静息状态及咳嗽状态下的视觉模拟评分法(VAS)评分、痛觉阈值,比较4组患者镇痛药物用量及自控镇痛有效按压次数和不良反应发生情况。结果对照组在术后2、4、8、24、48 h时的静息状态下VAS评分有明显变化,而低、中、高剂量组同组间在不同时间点的静息状态下VAS评分比较,差异均无统计学意义(P>0.05)。对照组,低、中、高剂量组在不同时间点同组间咳嗽状态下的VAS评分比较,差异均有统计学意义(P<0.05)。对照组,低、中、高剂量组同组间在术后2、4、8、12、24、48 h的痛觉阈值比较,差异均有统计学意义(P<0.05)。低、中、高剂量组术后2、4、8、12、24、48 h时的静息状态、咳嗽状态下VAS评分明显低于对照组,痛觉阈值高于对照组;中、高剂量组以上时间点的静息状态、咳嗽状态下VAS评分低于低剂量组,痛觉阈值明显高于低剂量组,差异均有统计学意义(P<0.05);中剂量组与高剂量组不同时间点下的静息状态、咳嗽状态下VAS评分、痛觉阈值比较,差异均无统计学意义(P>0.05)。低、中、高剂量组舒芬太尼用量及自控镇痛有效按压次数明显低于对照组,中、高剂量组舒芬太尼用量及自控镇痛有效按压次数明显低于低剂量组,差异均有统计学意义(P<0.05),中剂量组与高剂量组的舒芬太尼用量及自控镇痛有效按压次数比较,差异无统计学意义(P>0.05)。不良反应总发生率从低到高为中剂量组、低剂量组、高剂量组、对照组,但组间比较差异均无统计学意义(P>0.05)。结论采用超声引导下0.25%罗哌卡因竖脊肌平面阻滞联合全身麻醉对腹腔镜全子宫切除术患者的麻醉效果及疼痛阈值较好,可用于腹腔镜下全子宫切除术的麻醉中。

Objective To investigate the effects of different concentrations of ropivacaine erector spinae plane block combined with general anesthesia on the anesthetic effect and pain threshold of patients undergoing laparoscopic total hysterectomy.Methods Sixty patients undergoing elective laparoscopic total hysterectomy in Xuancheng City Central Hospital from January 2020 to July 2022 were prospectively divided into matched group,low-dose group,medium-dose group and high-dose group according to random number table method,each group 15 cases.The matched group were given general anesthesia,while the low medium and high-dose group were given ultrasond-guided 0.15%,0.25%,0.33%ropivacaine erecting spinae plane block combined with general anesthesia.The visual analogue scale(VAS)score and pain threshold in the resting state and cough state were compared among the four groups at 2,4,8,8,24 and 48 h after operation.The dosage of analgesic drugs and the effective pressure times of patient-controlled analgesia were compared among the four groups.The incidence of adverse reactions were compared among the four groups.Results In the control group,the VAS scores changed significantly in the resting state at 2,4,8,8,24 and 48 h after operation,while the low,medium,and high dose groups at different time points were not significant(P>0.05).VAS scores between control,low,medium and high dose groups at different time points,the differences were statistically significant(P<0.05).The control groups,low,medium,and high dose groups were significant at 2,4,8,12,24 and 48 h after surgery(P<0.05).The VAS scores in the resting state and cough state at 2,4,8,12,24 and 48 h after operation in the low-dose,medium-dose and high-dose groups were lower than those in the matched group,and the pain threshold was higher than that in the matched group,the differences were statistically significant(P<0.05).The VAS scores in the resting state and cough state at above time points in the medium-dose and high-dose groups were lower than those in the low-dose group.The pain threshold was higher than that in the low-dose group,the differences were statistically significant(P<0.05),but there was no difference in VAS score and pain threshold in the resting state,cough state between the medium-dose group and the high-dose group at different time points(P>0.05).The dosage of sufentanil and the effective pressure times of patient-controlled analgesia in the low,medium and high dose groups were lower than those in the matched group,and the dosage of sufentanil and the effective pressure times of patient-controlled analgesia in the medium and high dose groups were lower than those in the low dose group,the differences were statistically significant(P<0.05).There was no difference in sufentanil dosage and effective pressure times of patient-controlled analgesia between medium dose group and high dose group(P>0.05).The total incidence of adverse reactions from low to high were medium dose group,low dose group,high dose group and control group,but there was no significant difference between the groups(P>0.05).Conclusion Ultrasound-guided 0.25%ropivacaine erector spinae plane block combined with general anesthesia has good anesthetic effect and pain threshold in patients with laparoscopic total hysterectomy,which can be used in the anesthesia of laparoscopic total hysterectomy.