耳颞神经阻滞(ANB)在ROSA机器人辅助下颅内电极植入术后镇痛中的应用  

Application of auriculotemporal nerve block(ANB)in analgesia after ROSA robot assisted intracranial electrode implantation

作　　者：付君祚 张蕊[1] 王军[1] 周君 谢致 FU Jun-zuo;ZHANG Rui;WANG Jun;ZHOU Jun;XIE Zhi(Department of Anesthesiology,Shanghai Deji Hospital,the Ninth Clinical Medical College,Qingdao University,Shanghai 200333,China)

机构地区：[1]青岛大学第九临床医学院上海德济医院麻醉科,上海200333

出　　处：《复旦学报（医学版）》2020年第2期271-274,共4页Fudan University Journal of Medical Sciences

摘　　要：目的评估选择性耳颞神经阻滞(auriculotemporal nerve block,ANB)应用于ROSA机器人辅助下颅内电极植入术术后镇痛的效果。方法60例接受ROSA机器人辅助下颅内电极植入术的患者,年龄13~65岁,16<BMI≤29.9,ASAⅠ~Ⅱ级。采用随机数字表法分为耳颞神经阻滞组(ANB组,n=30)和静脉患者自控镇痛组(PCIA组,n=30)。ANB组在手术结束后用0.5%罗派卡因2~3 mL在超声引导下阻滞双侧耳颞神经,术后留置导管,每8 h通过留置导管推注0.5%罗哌卡因2 mL以维持神经阻滞效果;PCIA组术后配制镇痛泵,2μg/kg舒芬太尼+2μg/kg右美托咪啶+昂丹司琼8 mg+0.9%氯化钠注射液,稀释至100 mL。术后4、12、24和48 h记录患者的简化McGill疼痛评分和不良反应,包括恶心呕吐、皮肤瘙痒、呼吸抑制、低血压、心动过缓、局麻药中毒等。结果与PCIA组比较,ANB组术后4、12、24和48 h的McGill疼痛评分差异无统计学意义,ANB组的不良反应与12 h内张口咬合疼痛发生率明显低于PCIA组。结论超声引导下选择性ANB是ROSA机器人辅助下颅内电极植入术术后镇痛的有效方法,较PCIA镇痛更具优势。Objective To evaluate the effect of selective auriculotemporal nerve block(ANB)on postoperative analgesia after the operation of ROSA robot assisted intracranial electrode implantation.Methods Sixty patients with the application of ROSA robot assisted intracranial electrode implantation,aged 13-65 years old,16<BMI≤29.9,ASAⅠ~Ⅱ,were randomly divided into the ANB Group(n=30)and PCIA Group(n=30).In the ANB group,bilateral auriculotemporal nerves were blocked with 2-3 mL 0.5%ropivacaine under the guidance of ultrasound,After the operation,2 mL 0.5%ropivacaine was injected through the indwelling catheter every 8 h to maintain the nerve block effect.PCIA group was given an analgesic pump(2μg/kg sufentanil+2μg/kg dexmedetomidine+8 mg ondansetron+100 mL 0.9%physiological saline).Simplified McGill pain scores,adverse reactions(nausea and vomiting,itching,respiratory depression,hypotension,bradycardia,local anesthetic poisoning)were recorded at 4,12,24 and 48 hours after operation.Results There was no significant difference in McGill pain scores between ANB group and PCIA group at 4,12,24 and 48 hours after operation.The incidence of adverse reactions and mouth occlusion pain within 12 hours in ANB group was lower than that in PCIA group.Conclusion Ultrasound-guided selective ANB is an effective post-operative analgesia method for ROSA robot-assisted intracranial electrode implantation,and it has more advantages than PCIA analgesia.

关 键 词：ROSA 颅内电极植入术 神经阻滞 患者自控镇痛 耳颞神经 

分 类 号：R614.4[医药卫生—麻醉学]