区域阻滞对腔镜甲状腺切除术围术期镇痛及术后早期康复的影响

Effect of regional block on perioperative analgesia and early postoperative rehabilitation in patients undergoing endoscopic thyroidectomy

目的 探讨超声引导下双侧颈浅丛阻滞联合双侧颏神经阻滞对经口腔前庭入路腔镜甲状腺切除术围术期镇痛及术后早期康复的影响。方法 回顾性分析2020年6月至2022年10月河南中医药大学第一附属医院择期行全身麻醉下口腔前庭入路腔镜单侧甲状腺切除术90例患者的临床资料,按照随机数字表法分为颈浅丛阻滞联合颏神经阻滞复合全身麻醉组(S组)与单纯全身麻醉组(C组),每组45例。S组在麻醉诱导前行超声引导下双侧颈浅丛阻滞联合双侧颏神经阻滞,C组直接进行全身麻醉,两组患者术后进行自控静脉镇痛(PCIA),术后补救镇痛采用氟比洛芬酯50 mg。记录两组患者麻醉过程中的丙泊酚及瑞芬太尼的用量,术后24 h镇痛泵舒芬太尼用量、补救镇痛药物用量及术后恶心呕吐的发生情况,术后48 h行40项恢复质量评分量表(QoR-40)评分。结果 与C组比较,S组术中丙泊酚、瑞芬太尼总用量较少,术后2 h、6 h、12 h、24 h视觉疼痛模拟评分量表评分较低,术后24 h PCIA舒芬太尼用量及补救用药氟比洛芬酯用量较少,术后恶心发生率较低,差异有统计学意义(P<0.05)。与C组比较,S组术后48 h QoR-40评分更高,差异有统计学意义(P<0.05)。结论 超声引导下双侧颈浅丛阻滞联合双侧颏神经阻滞可为围术期提供有效镇痛,减少围术期麻醉药物用量,降低术后恶心呕吐发生率,改善术后康复质量。

Objective To investigate the effect of bilateral superficial cervical plexus block combined with bilateral mental nerve block under ultrasound guidance on perioperative analgesia and early postoperative rehabilitation in patients undergoing endoscopic thyroidectomy via oral vestibular approach.Methods The clinical data of 90 patients undergoing lumpectomy with unilateral thyroidectomy under general anesthesia with oral vestibular access in the First Affiliated Hospital of Henan Univesity of Traditional Chinese Medicine from June 2020 to October 2022 were retrospectively analyzed.The patients were randomly divided into two groups:superficial cervical plexus block combined with chin nerve block and general anesthesia(group S),and general anesthesia alone(group C),with 45 cases in each group.In group S,ultrasound guided bilateral superficial cervical plexus block combined with bilateral chin nerve block was performed before anesthesia induction.In group C,general anesthesia was performed directly.Patients in both groups received patient controlled intravenous analgesia(PCIA)after operation,and flurbiprofen axetil 50 mg was used for postoperative relief analgesia.The dosage of propofol and remifentanil during anesthesia,the dosage of analgesic pump sufentanil,the dosage of remedial analgesics and the incidence of postoperative nausea and vomiting were recorded in the two groups.The 40 items of recovery quality scale(QoR-40)was scored 48 hours after operation.Results Compared with group C,the total dosage of propofol and remifentanil during operation in group S was lower,the score of visual pain simulation scale was lower at 2 h,6 h,12 h and 24 h after operation,the dosage of PCIA sufentanil and the dosage of flurbiprofen axetil were lower at 24 h after operation,and the incidence of postoperative nausea was lower,the differences were significant(P<0.05).Compared with group C,the QoR-40 score in group S was higher at 48 hours after operation,and the difference was significant(P<0.05).Conclusions Ultrasound-guided bilateral superficial cervical plexus block combined with bilateral chin nerve block can provide effective analgesia in the perioperative period,reduce the amount of perioperative anesthetic drugs,decrease the incidence of postoperative nausea and vomiting,and improve the quality of postoperative recovery.