超声引导下前锯肌平面阻滞对乳腺癌根治术患者术后镇痛的影响  

Effect of ultrasound-guided serratus plane block on efficacy of postoperative analgesia in patients undergoing radical mastectomy

作　　者：韩超[1] 任鸿飞[1] 周敏敏[1] 郭燕芬[1] 阮志慧[1] 葛志军[1] 

机构地区：[1]江苏省宜兴市人民医院麻醉科,214200

出　　处：《临床麻醉学杂志》2016年第12期1173-1176,共4页Journal of Clinical Anesthesiology

摘　　要：目的探讨超声引导下前锯肌平面（serratus plane,SP）阻滞对乳腺癌根治术患者术后镇痛效果的影响。方法选择择期行全麻下乳腺癌根治术患者40例,年龄45~65岁,ASAⅠ或Ⅱ级,随机分为两组：SP阻滞组（SP组）和对照组（C组）,每组20例。麻醉诱导后行超声引导下术侧SP阻滞,SP组注射0.375%罗哌卡因20 ml,C组注射等容量生理盐水,术后均行舒芬太尼PCIA。于术后2、4、8、12、24h行Prince-Henry疼痛评分（PHPS）。记录术中瑞芬太尼用量及术后24h内舒芬太尼用量,24h内PCIA泵有效按压次数（D1）和实际按压次数（D2）,计算D1/D2。记录患者不良反应发生情况。结果 SP组PHPS疼痛评分在术后2h[（1.3±0.4）分vs.（3.0±0.5）分]、4h[（1.4±0.5）分vs.（2.9±0.7）分]、8h[（1.7±0.6）分vs.（2.7±0.6）分]明显低于C组（P〈0.05）。SP组术中瑞芬太尼用量[（287±41）μg vs.（375±66）μg]及术后24h内舒芬太尼用量[（54±17）μg vs.（88±25）μg]明显少于C组,D1/D2值（0.88±0.11vs.0.56±0.17）明显高于C组（P〈0.05）。两组均未见其他不良反应。结论超声引导下前锯肌平面阻滞能减轻乳腺癌根治术后患者早期疼痛,增强术后镇痛效果,减少围术期阿片类药物的用量。Objective To investigate the effect of ultrasound-guided serratus plane block on efficacy of postoperative analgesia in patients undergoing radical mastectomy.Methods Forty ASA physical statusⅠ orⅡ patients aged 45-65 years scheduled for radical mastectomy under general anesthesia were randomly divided into two groups（n=20each）：SP block group（group SP）and control group（group C）.After induction of anesthesia,ultrasound-guided homolateral SP block were performed,and 0.375%ropivacaine 20 ml was injected in group SP,while the equal volume of normal saline was used instead in group C.The patients received patient-controlled intravenous analgesia（PCIA）with sufentanil after operation in the two groups.The scores of prince henry pain scale（PHPS）were evaluated at 2,4,8,12 and 24hafter operation.The consumption of sufentanil,propofol and remifentanil were recorded,meantime the times of successfully delivered doses（D1）and attempts（D2）within 24 hafter operation were added up,calculating D1/D2.The adverse effects were also recorded.Results The scores of PHPS at postoperative 2h[（1.3±0.4）scores vs.（3.0±0.5）scores],4h [（1.4±0.5）scores vs.（2.9±0.7）scores],8h [（1.7±0.6）scores vs.（2.7±0.6）scores],and the consumption of sufentanil[（54±17）μg vs.（88±25）μg],remifentanil[（287±41）μg vs.（375±66）μg]were significantly lower in group SP than in group C,while D1/D2（0.88±0.11 vs.0.56±0.17）was higher（P〈0.05）.There were no adverse reactions in both groups.Conclusion Ultrasound-guided SP block reduces the perioperative opioids consumption and enhances the efficacy of postoperative analgesia in patients undergoing radical mastectomy.

关 键 词：超声引导 前锯肌平面阻滞 乳腺癌根治术 术后镇痛 

分 类 号：R614[医药卫生—麻醉学] R737.9[医药卫生—外科学]