右侧膈神经阻滞镇痛在腹腔镜胆囊切除术中的应用研究

Analgesic effects of right phrenic nerve block in multimodal analgesia for laparoscopic cholecystectomy

目的评价右侧膈神经阻滞镇痛在腹腔镜胆囊切除术(LC)后多模式镇痛中的作用及安全性。方法选择2022年9月至2023年3月于首都医科大学附属北京地坛医院麻醉科择期行LC患者80例,依照随机数字表法均分为膈神经阻滞镇痛组(P组)40例及对照组(C组)40例。P组于全麻诱导前先应用0.375%罗哌卡因6 mL行右侧膈神经阻滞,C组未行处理。两组均于胆囊切除后静脉注射羟考酮0.1 mg/kg,在缝皮前0.375%罗哌卡因15 mL切口浸润。记录患者术后4、8、12、24 h时肩部疼痛(PLSP)的视觉模拟量表(VAS)评分,当VAS评分≥4分时采用静脉注射曲马多50 mg进行补救性镇痛。记录术后患者镇痛满意度评分、术后PLSP(VAS评分≥4分)的发生例数及术后不良反应的发生情况。结果最终77例完成本研究,其中C组38例,P组39例。两组患者年龄、性别比、体重指数、手术时间以及术中丙泊酚、瑞芬太尼用量方面比较差异无统计学意义(P>0.05)。术后P组发生PLSP 1例(2.6%),少于C组的9例(23.7%),差异有统计学意义(P<0.05)。P组镇痛满意度评分(3.9±0.8)分,高于C组的(3.0±1.1)分,差异有统计学意义(P<0.05)。与C组比较,P组术后8、12、24 h静息及活动时PLSP的VAS评分均降低,差异有统计学意义(P<0.05)。P组发生术后恶心呕吐(PONV)1例(2.6%),C组4例(10.5%),两组不良事件发生率比较,差异无统计学意义(P>0.05)。结论联合膈神经阻滞的多模式镇痛可有效降低LC术后PLSP的发生率及疼痛程度,有较好的安全性。

Objective To evaluate the efficacy and safety of right phrenic nerve block in multimodal analgesia protocol for laparoscopic cholecystectomy(LC).Methods Eighty patients who underwent elective LC in the Department of Anesthesiology at Beijing Ditan Hospital Affiliated to Capital Medical University from September 2022 to March 2023,were selected and randomly divided into two groups(n=40 each):right phrenic nerve block group(Group P)and control group(Group C).Before general anesthesia induction,Group P received right phrenic nerve block with 6 mL of 0.375%ropivacaine,while Group C did not receive any intervention.After cholecystectomy,both groups received intravenous injection of oxycodone 0.1 mg/kg,and the surgical incision was infiltrated with 15 mL of 0.375%ropivacaine before suturing.The visual analog scale(VAS)scores for pain radiating to shoulders at 4,8,12,24 h after surgery were recorded,remedial analgesia was performed with intravenous tramadol 50 mg when the VAS pain score was≥4.The postoperative patient satisfaction score for pain relief,the number of cases of postoperative shoulder pain(VAS≥4),and the incidence of postoperative adverse reactions were recorded.Results A total of 77 patients completed the study,including 38 Group C and 39 in Group P.There were no statistically significant differences between the two groups of patients in terms of age,gender ratio,body mass index,surgical time,and the amount of propofol and remifentanil used during surgery(P>0.05).After surgery,there was 1 case(2.6%)of shoulder pain in Group P,which was less than 9 cases(23.7%)in Group C(P<0.05).The satisfaction score for pain relief in Group P(3.9±0.8)was higher than that in Group C(3.0±1.1)(P<0.05).Postoperative nausea and vomiting occurred in 1 patient(2.6%)in Group P and 4 patients(10.5%)in Group C.There was no statistically significant difference in the incidence of adverse events between the two groups.Conclusion Multimodal perioperative analgesia protocol with right phrenic nerve block effectively reduces the incidence and severity of postoperative shoulder pain,providing improved pain control to patients undergoing laparoscopic cholecystectomy.