超声引导下肋间臂神经阻滞治疗乳房切除术后疼痛综合征的临床效果  

Effect of ultrasound-guided intercostobrachial nerve blockade in patients with post-mastectomy pain syndrome

作　　者：黄接云 李敏[2] 江鹤群[2] 林孙枝[3] 

机构地区：[1]福建省南平市第一医院疼痛科,353000 [2]福州总医院麻醉科 [3]福建医科大学附属闽东医院疼痛科

出　　处：《临床麻醉学杂志》2017年第3期257-260,共4页Journal of Clinical Anesthesiology

摘　　要：目的观察及评价超声引导下肋间臂神经(ICBN)阻滞治疗保留ICBN的乳腺癌根治术术后顽固性疼痛的效果。方法选择2014年1月至2016年2月于我院行保留ICBN的乳腺癌根治术术后随访的女性患者53例,年龄18~55岁,ASAⅠ或Ⅱ级,其中术后出现术侧侧胸壁、腋窝和/或上臂顽固性疼痛,且持续超过3个月的患者有19例,经超声引导在第2肋间隙前锯肌浅面和胸小肌深面形成的潜在间隙内注入0.5%罗哌卡因10ml行ICBN阻滞,记录阻滞前、阻滞后30min和阻滞后1~7d患者静息(VAS_(静息))、运动(肩外展,VAS_(运动))及接受von Frey痛觉测试纤维丝100kPa压力刺激(VAS_(压力))时的VAS评分,并计算疼痛评分总和(SPI,SPI=VAS_(静息)+VAS_(运动)+VAS_(压力)),同时观察阻滞后1~7dSPI降低≥5分的患者例数。记录局麻药过敏、中枢神经系统和心血管系统毒性反应等阻滞相关不良反应。所有患者均接受7d疼痛评估随访。结果 19例患者均完成超声引导下ICBN阻滞,其中17例完成阻滞后7d的随访。患者阻滞前后SPI平均数差值为-9.19分(95%CI-11.24^-7.14,P<0.01)。与阻滞前比较,阻滞后30 min、阻滞后1~6d VAS_(静息)、VAS_(运动)、VAS_(压力)和SPI评分均明显降低(P<0.01或P<0.05)。阻滞后1~4dSPI降低≥5分的患者分别有14例(82.4%)、13例(76.5%)、7例(41.2%)和3例(17.6%)。所有患者均未出现局麻药过敏、中枢神经系统和心血管系统毒性反应等阻滞相关不良反应。结论超声引导下ICBN阻滞可安全有效地改善行保留ICBN的乳腺癌根治术患者术后顽固性疼痛。Objective To investigate and evaluate the feasibility and analgesic effect of ultrasound guided intercostobrachial nerve（ICBN）blockade in patients with persistent pain after radical mastectomy with ICBN preservation.Methods In a total of 53following-up female cases,aged 18-55 years,ASA Ⅰ orⅡ,receiving radical mastectomy with ICBN preservation during January,2014 to February,2016,19 patients complained persistent pain in the lateral chest,axilla and/or upper arm more than 3 months after the surgery were enrolled.ICBN blockade was performed using 0.5%ropivacine 10 mL injected in the potential space between the superior of pectoralis minor muscle and the inferior of serratus anterior muscle in the second intercostal space guided by ultrasound.Visual analogue scale（VAS）was applied to assess the pain intensity at rest,on movement,and with 100 kPa pressure before blockage and 30 min thereafter,and then the pain intensity（SPI）was calculated.All nerve blockade-related adverse events including local anesthetic-related allergy,central nervous system and cardiovascular toxicity were recorded.Seven-day follow-ups were required in all patients to assess the pain intensity.Results All 19 cases completed ICBN blockade guided by ultrasound,of which 17 cases completed the seven-day follow-ups.The mean difference in SPI was-9.19 VAS points（95%CI-11.24--7.14,P〈0.01）.Compared with each mean VAS and SPI before block,all that after block at day 1-6were significantly decreased（P〈0.01 or P〈0.05）.There were 14（82.4%）,13（76.5%）,7（41.2%）and 3（17.6%）cases that SPI was decreased over 5 points after block at day 1-4.No nerve blockade-related adverse event was observed.Conclusion Ultrasound guided ICBN blockade can relieve persistent post-mastectomy pain safely and effectively.

关 键 词：超声 肋间臂神经 乳房切除术 疼痛综合征 

分 类 号：R614[医药卫生—麻醉学] R737.9[医药卫生—外科学]