肋间神经前皮支联合阻滞用于乳腺癌改良根治术患者术后早期镇痛的效果:与单纯Ⅱ型胸神经阻滞比较  

Efficacy of combination of anterior cutaneous branch of intercostal nerve block and pectoral nerves block typeⅡfor early postoperative analgesia in patients undergoing modified radical mastectomy:a comparison with pectoral nerves block typeⅡ

作　　者：尤荻[1] 李凯[1] 赵加[1] 赵国庆[1] 李龙云[1] You Di;Li Kai;Zhao Jia;Zhao Guoqing;Li Longyun(Department of Anesthesiology,China-Japan Union Hospital of Jilin University,Changchun 130033,China)

机构地区：[1]吉林大学中日联谊医院麻醉科,长春130033

出　　处：《中华麻醉学杂志》2019年第5期571-573,共3页Chinese Journal of Anesthesiology

摘　　要：目的通过与单纯Ⅱ型胸神经阻滞(PecsⅡ)比较,评价肋间神经前皮支联合PecsⅡ用于全麻乳腺癌改良根治术患者术后早期镇痛的效果。方法择期全身麻醉下行乳腺癌改良根治术患者68例,年龄18~64岁,ASA分级Ⅰ-Ⅲ级,女性,采用随机数字表法分为2组(n=34):PecsⅡ+肋间神经前皮支阻滞组(P+A组)和单纯PecsⅡ组(P组)。2组患者均以芬太尼、丙泊酚和顺苯磺酸阿曲库铵全麻诱导后行气管插管术,七氟醚复合氧化亚氮维持麻醉。手术开始前,2组患者通过超声引导下胸大肌与胸小肌间隙给予0.25%左布比卡因10 ml,再于第3肋水平前锯肌表面给予0.25%左布比卡因10 ml行PecsⅡ;P+A组患者分别于第4和5肋骨与胸骨连接处的胸横肌与肋间肌间隙给予0.25%罗哌卡因10 ml(共20 ml)行肋间神经前皮支阻滞;P组给予等量生理盐水。VAS评分>3分或主动要求时给予吗啡镇痛,记录术后镇痛时间;记录术后24 h时累计吗啡用量;观察术后恶心呕吐的发生情况。结果与P组比较,P+A组术后24 h时累计吗啡用量降低,术后镇痛时间延长(P<0.05);2组术后恶心呕吐发生率差异无统计学意义(P>0.05)。结论肋间神经前皮支联合PecsⅡ用于乳腺癌改良根治术患者术后早期镇痛效果优于单纯PecsⅡ。Objective To evaluate the efficacy of anterior cutaneous branch of the intercostal nerve block combined with pectoral nerves(Pecs)block typeⅡfor early postoperative analgesia by comparing with Pecs block typeⅡin the patients undergoing modified radical mastectomy.Methods Sixty-eight patients,aged 18-64 yr,with American Society of Anesthesiologists physical statusⅠ-Ⅲ,scheduled for elective modified radical mastectomy under general anesthesia,were divided into 2 groups(n=34 each)using a random number table method:Pecs block typeⅡplus anterior cutaneous branch of intercostal nerve block group(P+A group)and Pecs block typeⅡgroup(P group).Anesthesia was induced with fentanyl,propofol and cisatracurium besilate,the patients were then tracheally intubated,and anesthesia was maintained with sevoflurane combined with nitrous oxide in both groups.In both groups,0.25%levobupivacaine 10 ml was injected into the space between pectoralis major and pectoralis minor under ultrasound guidance,and then 0.25%levobupivacaine 10 ml was injected into the surface of the serratus anterior muscle at the level of 3rd rib for Pecs block typeⅡbefore operation.In group P+A,0.25%ropivacaine 10 ml(20 ml in total)was injected into the interspace between the transverse thoracic and intercostal muscles in the junction area at the level of 4th and 5th ribs to perform anterior cutaneous branch of the intercostal nerve block.The equal volume of normal saline was given instead in group P.Morphine was given for analgesia when visual analogue scale score>3 or when the patients required.The cumulative amount of morphine administered at 24 h after surgery was recorded.The development of postoperative nausea and vomiting was observed.Results Compared with group P,the cumulative amount of morphine administered at 24 h after surgery was significantly decreased,and the postoperative analgesia time was prolonged in group P+A(P<0.05).There was no significant difference in the incidence of postoperative nausea and vomiting between the two groups(P

关 键 词：神经传导阻滞 疼痛 手术后 乳腺癌改良根治术 

分 类 号：R61[医药卫生—外科学]