超声引导下双侧颈浅丛阻滞对甲状腺术后咽喉疼痛的影响:一项前瞻性随机对照试验

Effect of ultrasound-guided bilateral superficial cervical plexus blocks on postoperative pain:a prospective,randomized,controlled trial

目的探讨超声引导下双侧颈浅丛阻滞对甲状腺手术术后咽喉疼痛的影响。方法纳入拟行全身麻醉下甲状腺切除术的患者共计160例,随机分为2组:颈浅丛组(R组,n=80)和对照组(S组,n=80),在超声引导下定位双侧颈浅神经丛后分别注射10 mL 0.5%罗哌卡因或生理盐水。主要观察指标为术后2、6、24、48 h吞咽时咽喉疼痛VAS分值,次要观察指标为切口疼痛程度,补救镇痛药的使用情况,术中芬太尼的用量,术后48 h内恶心、呕吐的发生率,1周内感染情况以及神经阻滞相关并发症(局部麻醉药物中毒,穿刺点出血、血肿等)。结果甲状腺切除术后疼痛多发生于24 h内,之后疼痛分值显著下降(P<0.05)。两组在术后2、6、24、48 h的咽喉疼痛VAS评分(包括静态评分和动态评分)差异无统计学意义(P>0.05)。R组术后6 h和24 h切口运动疼痛的VAS分值明显小于S组(P<0.05),其他时间点的切口疼痛均无显著差异;术中芬太尼的使用量,补救镇痛药的使用率、恶心呕吐的发生率以及术后1周的感染率相似,差异无统计学意义(P>0.05)。结论超声引导下双侧颈浅丛阻滞可有效缓解甲状腺术后24 h内的切口疼痛,但是无法缓解和改善咽喉疼痛。

Objective To investigate the effect of ultrasound-guided bilateral superficial cervical plexus blocks on postoperative pain in patients undergoing thyroidectomy.Methods A total of 160 patients scheduled for thyroidectomy under general anesthesia were randomly divided into study group and control group with 80 cases in each group,10 mL 0.5%ropivacaine or saline were injected after localization of the superficial cervical plexus bilaterally under ultrasound guidance,respectively.The primary outcomes were VAS scores for throat pain and incisional pain in the surgical region at 2,6,24 and 48 h postoperatively,and secondary outcomes were the use of remedial analgesics,intraoperative fentanyl dosage,incidence of nausea and vomiting at 48 h postoperatively,infection at 1 week and nerve block-related complications(local anaesthetic toxicity,bleeding at the puncture site,haematoma,etc.).Results Pain after thyroidectomy occurred mostly within 24 h,then the pain scores decreased significantly in both groups(P<0.05).The VAS scores of pharyngeal pain(including static and dynamic scores)were not statistically different between the two groups at 2,6,24 and 48 h postoperatively(P>0.05).The VAS scores of incisional motor pain at 6 h and 24 h postoperatively were significantly lower in the study group than those in the control group(P<0.05),and there was no significant difference at other time points.There were no significant differences in intraoperative use of fentanyl,the use of remedial analgesics,the incidence of intraoperative fentanyl use,the incidence of nausea and vomiting and the rate of infection at 1 week postoperatively between two groups(P>0.05).Conclusion Ultrasound-guided bilateral superficial cervical plexus blocks are effective in relieving incisional pain within 24 h after thyroid surgery,but not pharyngeal pain.