区域阻滞技术在胸外科手术围术期疼痛管理中的应用

Application of regional block technique in perioperative pain management of thoracic surgery

目的观察区域阻滞技术在胸外科手术围术期疼痛管理中的应用。方法回顾性分析河南中医药大学第一附属医院2022年1月—2022年12月择期行全麻下胸外科手术的120例患者,根据麻醉方法将患者分为两组,S组:区域阻滞复合静脉自控镇痛(patients controlled analgesia,PCA)组(60例),C组:单纯PCA组(60例)。S组在麻醉诱导前行超声引导下区域阻滞技术,术后患者采用静脉镇痛,C组只采用静脉镇痛,两组患者术后均接受急性疼痛服务小组(acute pain service,APS)的疼痛管理;记录患者术后补救镇痛次数、APS小组的额外出访次数、患者术后6 h、12 h、24 h、48 h的疼痛评分(visual analogue scale,VAS)及不良反应(恶心呕吐、呼吸抑制、瘙痒等)的发生率、电话随访并记录患者3个月后慢性疼痛的发生率。结果与C组相比,S组患者术后6 h、12 h、24 h、48 h VAS评分较低,术后补救镇痛的次数需求更少,同时S组患者术后3个月慢性疼痛发生率更低,两组之间差异具有统计学意义(P<0.05)。与C组相比,S组术后APS小组的“额外出访次数”更少,两组差异具有统计学意义(P<0.05)。结论在胸外科手术中采用区域阻滞技术能够给患者带来更好的镇痛效果,同时可以减少APS小组的“额外的出访次数”,减轻医务工作者的工作量,使得医疗资源得到优化和合理利用。

Objective To observe the application of regional block technique in perioperative pain management of thorac-ic surgery.Methods Totally 120 patients were divided into two groups:regional block technique plus patients con-trolled analgesia(Group S,n=60),patients controlled analgesia(Group C,n=60).Patients in group S were given re-gional block under ultrasound guidance before anesthesia induction in addition to patients controlled analgesia,while pa-tients in group C were only given patients controlled analgesia.Patients in both groups received postoperative pain manage-ment by APS.The times of postoperative salvage analgesia at 3 months postoperatively,the number of extra visits of APS group,the visual analogue scale(VAS)at 6 h,12 h,24 h and 48 h after operation,the incidence of adverse reactions(nausea,vomiting,respiratory depression,pruritus,etc.),and the incidence of chronic pain.Results Comparedwith Group C,group S had lower VAS scores at 6 h,12 h,24 h and 48 h postoperatively and less need for postoperative salvage analgesia.Meanwhile,group S had a lower incidence of chronic pain at 3 months postoperatively,the differ-ence between the two groups was statistically significant(P<0.05);Compared with Group C,group S had fewer times of extra visits after surgery,with a significant difference between the two groups.Conclusion Regional block tech-niques in the thoracic surgery can provide better analgesia for patients,while reducing the“additional visits”of the APS team and reducing the workload of the medical staff,can make the medical resources get the optimization and the reasonable utilization.