改良超声引导双侧颈浅丛阻滞对甲状腺手术围术期阿片类药物用量影响的临床观察

Clinical observation on the effect of modified ultrasound-guided bilateral superficial cervical plexus block on perioperative opioid dosage in thyroid surgery

目的 探讨改良超声引导双侧颈浅丛阻滞(modified ultrasound-guided bilateral superficial cervical plexus block,MUBSCPB)对甲状腺手术围术期阿片类药物用量的影响。方法 选取2019年9月至2021年9月首都医科大学附属北京同仁医院择期行全麻下甲状腺手术(颈部开放性切口)的住院患者80例,采用随机数字法分为MUBSCPB组和对照组,每组40例。MUBSCPB组在全麻诱导气管插管后,左右两侧均在超声引导下,以耳大神经在胸锁乳突肌后缘的穿出点为靶点,注射0.5%盐酸罗哌卡因8 ml,完成颈浅丛阻滞;对照组采用单纯全麻法。比较两组术中瑞芬太尼与丙泊酚每小时用量,吗啡累计用量(术后24 h、48 h),麻醉术后恢复室(post-anesthesia care unit,PACU)清醒后1 min及术后4 h、12 h、24 h、48 h的疼痛数字评分法(numerical rating scale,NRS)评分,术后补救镇痛比例,术后24 h内术后恶心呕吐(postoperative nausea and vomiting,PONV)发生率及止吐药物应用比例。结果 80例患者中,男31例,女49例,年龄20~65岁,平均(45.0±11.3)岁。MUBSCPB组瑞芬太尼每小时用量和术后24 h、48 h的吗啡累计用量低于对照组[(456.3±115.9)μg/h比(589.5±124.8)μg/h和3.9(2.4,5.4)mg比11.9(6.3,16.4)mg、6.8(5.8,8.8)mg比19.1(8.1,22.8)mg],PACU清醒后1 min和术后4 h、12 h的NRS评分低于对照组[1(1,2)比4.5(3,5.8)和1(0,1)比4(3,4)、1(0,1)比3(3,4)],术后补救镇痛比例、术后24h内PONV发生率和止吐药应用比例低于对照组(12.5%比45.0%、12.5%比32.5%和10.0%比27.5%)。结论 MUBSCPB可降低甲状腺术中瑞芬太尼用量及术后镇痛药物吗啡的用量,术后镇痛效果较好,同时可降低PONV发生率,提高甲状腺手术麻醉质量。

Objective To explore the influence of modified ultrasound-guided bilateral superficial cervical plexus block(MUBSCPB) on the dosage of opioids during and after thyroid surgery.Methods A total of 80 patients with thyroid surgery(open neck incision) under general anesthesia in Beijing Tongren Hospital affiliated to Capital Medical University from September 2019 to September 2021 were selected,and were randomly devided into MUBSCPB group and control group,with 40 cases in each group.In MUBSCPB group,after tracheal intubation induced by general anesthesia,the superficial cervical plexus block was completed by injecting 8 ml of 0.5% ropivacaine hydrochloride with the puncture point of the great auricular nerve at the posterior edge of sternocleidomastoid muscle under the guidance of ultrasound on both sides.The control group was given simple general anesthesia.The intraoperative remifentanil and propofol requirement per hour,the postoperative morphine consumption in the first 24 h and 48 h,the postoperative pain numerical rating scale(NRS) scores of post-anesthesia care unit(PACU)and post-operation at 4 h,12 h,24 h,28 h,the incidence of total 24 h postoperative nausea and vomiting(PONV),as well as the incidence of postoperative salvage analgesia and antiemetic were compared between the two groups.Results Among the 80 patients,there were 31 males and 49 females,aged from 20 to 65years,with an average age of(45.0 ± 11.3) years.The dosage of remifentanil per hour and the cumulative dosage of morphine at 24 h and 48 h after operation in MUBSCPB group were lower than those in control group [(456.3 ± 115.9) μg/h vs.(589.5 ± 124.8) μg/h,3.9(2.4,5.4) mg vs.11.9(6.3,16.4) mg,6.8(5.8,8.8) mg vs.19.1(8.1,22.8) mg],the NRS scores at 1 min after PACU awake and 4 h and 12 h after operation were lower than those in the control group [1(1,2) vs.4.5(3,5.8),1(0,1) vs.4(3,4),1(0,1) vs.3(3,4)],the proportion of postoperative salvage analgesia,the incidence of PONV within 24 h after operation and the proportion of antiemetic application were lower than those in the control group(12.5% vs.45%,12.5% vs.32.5%,10% vs.27.5%).Conclusions MUBSCPB can reduce the dosage of remifentanil and morphine in thyroid surgery with good postoperative analgesic effect,and can also reduce the incidence of PONV and improve the quality of anesthesia in thyroid surgery.