超声引导下竖脊肌平面阻滞与胸椎旁阻滞用于乳腺癌改良根治术后镇痛效果的比较

Comparison of ultrasound-guided erector spine muscle block and thoracic paravertebral block for postoperative analgesia after modified radical mastectomy for breast cancer

目的比较超声引导下竖脊肌平面阻滞与胸椎旁阻滞用于乳腺癌改良根治术后镇痛的效果。方法选取2018年1月至2020年1月于本院行乳腺癌改良根治术的62例老年患者作为研究对象,按照随机数字表法分为实验组和对照组,每组31例。两组均于全身麻醉下行乳腺癌改良根治术,麻醉诱导前行区域阻滞,实验组行竖脊肌平面阻滞(ESPB),对照组行胸椎旁神经阻滞(TPVB),比较两组术后3、6、9、12及24 h的视觉模拟评分法(VAS)评分、伯格曼舒适度量表(BCS)评分和术后24 h自控静脉镇痛(PCIA)有效按压次数(D1)/实际按压次数(D2)值、阻滞完成时间、阻滞起效时间、阻滞维持时间及穿刺不良反应发生情况。结果术后3、6、9、12及24 h,两组VAS、BCS评分比较差异无统计学意义。两组术后24 h PCIA D1/D2值比较差异无统计学意义。实验组阻滞完成时间、阻滞起效时间均短于对照组(P<0.05),但两组阻滞维持时间比较差异无统计学意义。实验组不良反应发生率为12.90%,低于对照组的48.39%,差异有统计学意义(P<0.05)。结论超声引导ESPB可代替TPVB用于老年患者乳腺癌改良根治术的术后镇痛,可有效缩短阻滞完成时间、阻滞起效时间,降低穿刺不良反应发生率,值得临床推广应用。

Objective To compare the effect of ultrasound-guided erector spine plane block and thoracic paravertebra block for postoperative analgesia after modified radical mastectomy for breast cancer.Methods 62 elderly patients who underwent modified radical mastectomy for breast cancer in our hospital from January 2018 to January 2020 were selected as the research subjects,and they were divided into the experimental group and the control group according to random number table method,with 31 cases in each group.Both groups underwent modified radical mastectomy for breast cancer under general anesthesia,anesthesia induced was performed with regional block,the experimental group was given erector spinae plane block(ESPB),the control group was given thoracic paravertebral block(TPVB),the visual analogue scale(VAS)score and the Bergman comfort scale(BCS)score at 3,6,9,12 and 24 h after operation,and the values of effective compression times(D1)/actual compression times(D2)of patient-controlled intravenous analgesia(PCIA)at 24 h after operation,block completion time,block onset time,block maintenance time,and the occurrence of adverse reactions of puncture were compared between the two groups.Results There was no significant difference in VAS and BCS scores between the two groups at 3,6,9,12 and 24 h after operation.There was no significant difference in PCIAD1/D2 values between the two groups at 24 h after operation.The block completion time,the block onset time in the experimental group were shorter than those in the control group(P<0.05),but there was no significant difference in the block maintenance time between the two groups.The incidence of adverse reactions of puncture in the experimental group was 12.90%,which was lower than 48.39%in the control group,and the difference was statistically significant(P<0.05).Conclusion Ultrasoundguided ESPB can replace TPVB for postoperative analgesia in elderly patients with modified radical mastectomy for breast cancer,which can effectively shorten the block completion time,block onset time,reduce the incidence of adverse reactions of puncture,it is worthy of clinical application.