三叉神经痛微血管减压术患者围手术期多模式镇痛方案比较

Comparison of perioperative multimodal analgesic regimens for patients with trigeminal neuralgia undergoing microvascular decompression surgery

目的探讨三叉神经痛微血管减压术患者围手术期多模式镇痛方案。方法选取2017年4月至2019年4月中南大学湘雅医院收治的因三叉神经痛拟行微血管减压术的80例患者,将患者按随机数字表法分为神经阻滞组(A组)和对照组(C组),每组40例。A组于麻醉诱导前在B超引导下行手术侧枕小神经和耳大神经阻滞,每个位点均用0.5%罗哌卡因3 ml。C组不进行神经阻滞。两组均静脉注射咪达唑仑、舒芬太尼、顺式阿曲库铵、依托咪酯和利多卡因行麻醉诱导,随后行气管插管,并用丙泊酚和瑞芬太尼维持麻醉,术毕接上镇痛泵。记录两组术中舒芬太尼与瑞芬太尼使用总量,术后2、6、24、48 h疼痛视觉模拟评分(VAS),术后麻醉相关并发症。结果A组术中舒芬太尼和瑞芬太尼使用总量少于C组(均P<0.05)。A组患者术后恶心呕吐发生率低于C组(P<0.05),恶心呕吐评分也低于C组(P<0.05),其他术后并发症发生率差异无统计学意义(均P>0.05)。术后6 h两组的VAS差异有统计学意义(P<0.05)。结论枕小神经和耳大神经阻滞可减少三叉神经痛患者微血管减压术中阿片类药物使用量,从而降低恶心呕吐发生率,术后镇痛效果良好。

Objective To explore a multimodal perioperative analgesia plan for patients undergoing microvascular decompression surgery for trigeminal neuralgia.MethodsEighty patients who underwent microvascular decompression surgery for trigeminal neuralgia admitted to the Xiangya Hospital,Central South University from April 2017 to April 2019 were randomly divided into a nerve block group(group A)and a control group(group C)using a random number table method,with 40 patients in each group.The group A underwent surgical block of the lateral occipital and auricular nerves under ultrasound guidance before induction,with 3 ml of 0.5%ropivacaine used at each site.The group C did not undergo nerve block.Both groups received intravenous injections of midazolam,sufentanil,cisatracurium,etomidate,and lidocaine for anesthesia induction,followed by tracheal intubation and maintenance of anesthesia with propofol and remifentanil.After surgery,an analgesic pump was connected.The total amount of intraoperative use of sufentanil and remifentanil in both groups was recorded,as well as the pain Visual Analogue Scale(VAS)and postoperative anesthesia related complications at 2,6,24,and 48 hours after surgery.ResultslThe total amount of sufentanil and remifentanil used during surgery in the group A was less than that in the group C(all P<0.05).The incidence of postoperative nausea and vomiting in the group A patients was lower than that in the group C(P<0.05),and the nausea and vomiting score was also lower than that in the group C(P<0.05).There was no statistically significant difference in the incidence of other postoperative complications(all P>0.05).There was a statistically significant difference in VAS scores between the two groups at 6 hours after surgery(P<0.05).ConclusionsOccipital and auricular nerve blockade can reduce the amount of opioid drugs used during microvascular decompression surgery in patients with trigeminal neuralgia,thereby reducing the incidence of nausea and vomiting.The postoperative analgesic effect is good.