超声引导下胸神经阻滞与左布比卡因、地塞米松胸椎旁阻滞对改良根治性乳房切除术后的镇痛效果比较

Comparative efficacy of ultrasound-guided pectoral nerve block versus Western medicine-assisted thoracic paravertebral block on postoperative analgesia in modified radical mastectomy patients

目的比较胸椎旁阻滞(TPVB)和胸神经阻滞(PecSⅡ)对改良根治性乳房切除术(MRM)的镇痛效果。方法选取2019年1月至2021年2月接受单侧改良的根治性乳房切除术(MRM)并具有完整随访记录的女性患者200例,按照随机抽签法分为观察组和对照组,其中接受胸神经阻滞(PecSII)镇痛患者(观察组)100例,接受胸椎旁椎体阻滞(TPVB)镇痛患者(对照组)100例。比较2组镇痛持续时间和总镇痛需求,数字评分休息时(NRS-R)和运动时(NRS-M)的评分。结果观察组的镇痛持续时间明显高于对照组,差异有统计学意义(P<0.05);观察组的24 h吗啡用量吗啡抢救剂量明显低于对照组,差异有统计学意义(P<0.05);观察组术后NRS-R的2 h、4 h、6 h、10 h评分明显低于对照组,差异有统计学意义(P<0.05);观察组术后NRS-M的2 h、4 h、6 h、10h评分明显低于对照组,差异有统计学意义(P<0.05)。结论在接受MRM的患者中,0.25%左旋布比卡因和4 mg地塞米松在PecSⅡ阻滞中提供较TPVB更长的镇痛持续时间,且未见明显不良反应。

Objective To compare the analgesic effect of thoracic paravertebral block(TPVB)and pectoral nerve block(Pecs)II on postoperative analgesia in patients with modified radical mastectomy(MRM).Methods A total of 200 female patients with unilateral modified radical mastectomy(MRM)and complete follow-up records in our hospital from January 2019 to February 2021 were enrolled.They were randomized 1∶1 to Pecs II(the observation group)or TPVB(the control group).The primary outcome was the duration of analgesia and total rescue analgesic required,and the Numeric Rating Scale at rest(NRS-R)and Numeric Rating Scale with movement(NRS-M)were numerically scored.Results The duration of analgesia in the observation group was significantly higher than that in the control group(P<0.05),respectively).The 24-hour morphine consumption were significantly lower in the observation group than in the control group(P<0.05).The scores of NRS-R and NRS-M on hours 2,4,6 and 10 in the observation group were significantly lower than those in the control group(P<0.05).Conclusion Among patients receiving MRM,0.25%levobupivacaine and 4 mg dexamethasone provide longer duration of analgesia in PecS II block than TPVB without any adverse effects.