超声引导下改良阴部神经阻滞用于肛周脓肿镇痛的临床研究

Clinical study of ultrasound-guided modified pudendal nerve block for analgesia of perianal abscess

目的分析超声引导下改良阴部神经阻滞用于肛周脓肿镇痛的临床研究。方法采取前瞻性随机对照研究方法,选择2020年1月至2022年12月在四川省第二中医医院行手术治疗的120例肛周脓肿患者作为研究对象,采用随机数字表法分为2组,每组60例。2组均实施腰硬联合麻醉,在此基础上,对照组术后给予阿司匹林镇痛,观察组术后给予超声引导下改良阴部神经阻滞镇痛,比较2组手术结束时、术后48 h、术后72 h疼痛程度[视觉模拟评分法(VAS)],比较2组术前、术后48 h、术后72 h的炎性因子水平[C-反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)],比较2组补救镇痛率及不良反应发生情况。结果观察组术后48 h、术后72 h VAS评分均低于对照组,组间、时点、组间·时点交互比较有差异(P<0.05);观察组术后48 h、术后72 h CRP、IL-6、TNF-α水平均低于对照组,组间、时点、组间·时点交互比较有差异(P<0.05);观察组术后48 h、术后72 h睡眠质量均高于对照组,组间、时点、组间·时点交互比较有差异(P<0.05);观察组补救镇痛率低于对照组,差异有统计学意义(P<0.05);2组不良反应发生情况比较无差异(P>0.05)。结论超声引导下改良阴部神经阻滞可有效减轻肛周脓肿患者术后疼痛程度,降低炎性因子水平,提高睡眠质量,减少术后补救镇痛次数,且安全性较好。

Objective To analyze the ultrasound-guided modified pudendal nerve block for analgesia of perianal abscess.Methods A prospective randomized controlled study was conducted.A total of 120 patients with perianal abscess who underwent surgical treatment in Sichuan Second Hospital of TCM from January 2020 to December 2022 were selected as the study subjects.They were randomly divided into two groups using a random number table method,with 60 patients in each group.Patients in both groups received combined spinal and epidural anesthesia.Patients in the control group received postoperative aspirin analgesia,and those in the observation group received postoperative ultrasound-guided modified pudendal nerve block analgesia.The pain degree at 0h,48h and 72h postoperative was assessed by the Visual Analogue Scale(VAS)and compared between groups.The levels of inflammatory factors,including C-reactive protein(CRP),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)before operation,48h and 72h after operation were compared between the two groups.The remedial analgesia rate and adverse events were compared between the two groups.Results The VAS scores at 48h and 72h postoperatively in the observation group were significantly lower than those of the control group,showing a significant difference between groups,time points,and groups×time points(P<0.05).CRP,IL-6,and TNF-αlevels at 48h and 72h postoperatively in the observation group were significantly lower than those of the control group,showing significant differences between groups,time points,and groups×time points(P<0.05).The sleep quality at 48h and 72h postoperatively in the observation group was significantly higher than that of the control group,showing a significant difference between groups,time points,and groups×time points(P<0.05).The remedial analgesia rate in the observation group was significantly lower than that of the control group(P<0.05).There was no significant difference in the incidence of adverse events between groups(P>0.05).Conclusion Ultrasound-guided modified pudendal nerve block can effectively alleviate postoperative pain in patients with perianal abscess,and reduce the levels of inflammatory factors and the number of postoperative relief analgesia,improve sleep quality,with a good safety.