蝶腭神经节阻滞在内镜鼻窦手术后疼痛管理中的应用

Application of sphenopalatine ganglion block for the management of postoperative pain after endoscopic sinus surgery

目的观察蝶腭神经节阻滞(sphenopalatine ganglion block,SPGB)对接受内镜鼻窦手术患者术后疼痛的治疗效果。方法选择60例接受内镜鼻窦手术的患者,采取随机数字表法分为单纯全身麻醉组(G组,30例)和全身麻醉加内镜下SPGB组(S组,30例)。全身麻醉诱导后,S组在鼻内镜下行SPGB,G组给予等容量的生理盐水。记录患者手术时间和术中出血量,术后到达PACU时及术后2、6、12、24 h的VAS疼痛评分,术后24 h和术后7 d镇痛药物使用次数、患者对疼痛控制的总体满意度,并发症(出血、头痛、恶心和呕吐、视力障碍)的发生情况。结果两组患者术中出血量S组少于G组,差异有统计学意义(P<0.05)。与G组比较,S组患者术后到达PACU时以及术后2、6、12、24 h的VAS疼痛评分降低(P<0.05),S组患者术后24 h和术后7 d镇痛药物使用次数减少(P<0.05),患者总体满意度增高(P<0.05)。两组患者并发症发生情况差异无统计学意义(P>0.05)。结论全身麻醉联合SPGB是一种减轻内镜鼻窦手术后疼痛的安全、有效方法,能够减少术后镇痛药物的应用。

Objective To observe the effect of sphenopalatine ganglion block(SPGB)on postoperative pain in patients undergoing endoscopic sinus surgery.Methods A total of 60 patients who underwent endoscopic sinus surgery were enrolled.According to the random number table method,they were divided into two groups:a general anesthesia group(group G,n=30)and a general anesthesia plus endoscopic SPGB group(group S n=30).Group S was received SPGB under nasal endoscopy.Group G was given the eqaul volume of normal saline.The duration of operation and intraoperative blood loss were recorded.Their Visual Analogue Scale(VAS)scores upon arrival to the post anesthesia care unit(PACU)and at postoperative 2,6,12 h and 24 h were recorded.The overall consumption of analgesics was recorded at postoperative 24 h and 7 d.The patients'overall satisfaction with pain control and complications were recorded at postoperative 24 h and 7 d.Results Compared with group G,intraoperative blood loss decreased in group S(P<0.05).Compared with group G,group S showed decreases in VAS score upon arrival to the PACU and at postoperative 2,6,12 h and 24 h(P<0.05).Furthermore,patients in group S presented reduced analgesic requirements,with improved overall satisfaction at postoperative 24 h and 7 d(P<0.05).There was no statistical differences in complications between the two groups(P>0.05).Conclusions General anesthesia combined with SPGB is a safe and effective method to relieve pain after endoscopic sinus surgery,and can reduce the consumption of postoperrative analgesics.