超声引导下星状神经节阻滞联合前锯肌平面阻滞对乳腺癌根治术患者术后急性疼痛及睡眠时间的影响

Effects of Ultrasound-Guided Stellate Ganglion Block Combined with Serratus Anterior Plane Block on Postoperative Acute Pain and Sleep Time in Patients Undergoing Radical Mastectomy

目的:探讨超声引导下星状神经节阻滞(U-SGB)联合前锯肌平面滞(U-SAPB)对乳腺癌根治术患者术后急性疼痛及睡眠时间的影响。方法:乳腺癌根治术女性患者120例随机均分为对照组、U-SAPB组和联合组(U-SGB联合U-SAPB),每组40例。对照组患者仅行全身麻醉,U-SAPB组患者行U-SAPB,联合组患者行U-SGB联合U-SAPB,术后均给予患者自控静脉镇痛(PCIA)。比较三组患者术后不同时间点的疼痛强度视觉模拟评分(VAS)、术后3天内夜间睡眠持续时间、术后首次按压镇痛泵时间及有效按压次数。结果:与对照组相比,联合组患者术后各个时间点VAS评分显著降低(P<0.05)、首次按压镇痛泵时间明显推迟、术后镇痛泵有效按压次数减少、术后3天内夜间睡眠持续时间更长(P<0.05);与U-SAPB组相比,联合组患者VAS评分在术后8 h及之后更优、术后首次按压镇痛泵时间更晚(P<0.05)。结论:与单纯全身麻醉、前锯肌平面阻滞相比,超声引导下星状神经节阻滞联合前锯肌平面阻滞能有效缓解乳腺癌患者的术后急性疼痛,延长术后早期夜间睡眠持续时间。

Objective:To explore the effects of ultrasound-guided stellate ganglion block(U-SGB)combined with ultrasound-guided serratus anterior plane block(U-SAPB)on postoperative acute pain and sleep duration in patients undergoing radical mastectomy.Methods:120 female patients who underwent radical mastectomy were randomly divided into the control group,the U-SAPB group and the combined group(U-SGB combined with U-SAPB),with 40 cases in each group.Patients of the control group received only general anesthesia,patients of the U-SAPB group received U-SAPB,and patients of the combined group received U-SGB and U-SAPB.All patients were given patient-controlled intravenous analgesia(PCIA)after surgery.The visual analogue scale(VAS)of pain intensity,the duration of nocturnal sleep,the time of first pressing the analgesic pump and the number of effective presses were compared among the three groups at different time points after surgery.Results:Compared with the control group,the VAS scores of the combined group were significantly lower at all time points after surgery(P<0.05),the time of first pressing the analgesic pump was significantly delayed,the number of effective presses of the analgesic pump was reduced,and the duration of nocturnal sleep was longer within 3 days after surgery(P<0.05);compared with the U-SAPB group,the VAS scores of the combined group were better at 8 h and later after surgery,and the time of first pressing the analgesic pump was later(P<0.05).Conclusion:Compared with simple general anesthesia and serratus anterior plane block,ultrasound-guided stellate ganglion block combined with serratus anterior plane block can effectively alleviate postoperative acute pain in breast cancer patients,prolong the duration of early nocturnal sleep.