耳大神经阻滞联合耳颞神经阻滞在中耳显微手术低阿片化麻醉的应用  

Application of Great Auricular Nerve Block Combined with Auriculo-Temporal Nerve Block in Opioid-Sparing Anesthesia during Middle Ear Microsurgery

作　　者：吴高辉 杨保仲 杨彩霞[1] 颜楠 井子夜[3] WU Gao-hui;YANG Bao-zhong;YANG Cai-xia;YAN Nan;JING Zi-ye(College of Anesthsiology,Shanxi Medical University,Taiyuan 030001,Shanxi China;Department of Anesthesiology,Taiyuan Central Hospital,Taiyuan 030001,Shanxi,China;Department of Anesthesiology,The First Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi,China)

机构地区：[1]山西医科大学麻醉学院,山西太原030001 [2]太原市中心医院麻醉科,山西太原030001 [3]山西医科大学第一医院麻醉科,山西太原030001

出　　处：《中国现代手术学杂志》2022年第6期480-485,共6页Chinese Journal of Modern Operative Surgery

摘　　要：目的 探讨耳大神经阻滞(great auricular nerve block, GANB)联合耳颞神经阻滞(auriculo-temporal nerve block, ATNB)用于中耳显微手术低阿片化麻醉的效果。方法 选择择期全麻下行中耳显微手术患者64例,按随机数字表法分为两组:耳大神经阻滞+耳颞神经阻滞组(G+B组)和单纯全麻组(G组),最终每组各纳入30例。G+B组麻醉诱导前在超声引导下进行GANB和ATNB, G组行单纯全身麻醉。两组麻醉诱导方案和麻醉维持方案相同。术后使用舒芬太尼补救镇痛以维持疼痛评分<4分,用甲氧氯普胺止吐以维持恶心呕吐(PONV)评分<5分。监测麻醉诱导后1 min(T1)、手术切皮后1 min(T2)血流动力学参数(MAP、HR)变化;记录瑞芬太尼、丙泊酚用量及持续输注时间、全麻时间;进行PACU(转入后10 min)和术后4 h、12 h、24 h、48 h疼痛VAS评分、PONV评分;统计术后48 h内补救镇痛率和止吐率。结果 组间比较,G+B组瑞芬太尼用量明显减少,切皮后1 min(T2)MAP降低,PACU及术后4 h、12 h疼痛VAS评分、PACU及术后4 h、12 h、24 h PONV评分、术后48 h内补救镇痛率及止吐率均显著低于G组,差异均有统计学意义(P<0.05)。结论 超声引导下GANB联合ATNB可减少中耳显微手术中瑞芬太尼的用量,缓解术中血流动力学变化,降低患者术后镇痛和止吐需求。Objective To investigate the effect of great auricular nerve block(GANB) combined with auriculo-temporal nerve block(ATNB) for opioid-sparing anesthesia in middle ear microsurgery. Methods 64 patients underwent selective middle ear microsurgery under general anesthesia were divided into group G+B and group G randomly according to random number table, and 30 patients for each group finally. GANB and ATNB were performed under ultrasound guidance before anesthesia induction in group G+B, and general anesthesia was performed only in G group. Anesthesia induction plan and anesthesia maintenance plan were same in both groups. Sufentanil was used for postoperative relief analgesia to maintain pain score less than 4 points, and metoclopramide was used to treat postoperative nausea and vomiting(PONV) to maintain PONV score less than 5 points. Hemodynamic parameters of MAP and HR were observed at the time of 1 min after anesthesia induction(T1) and 1 min after skin resection(T2). Continuous infusion time and dosage of propofol and remifentanil, general anesthesia time, VAS score and PONV score in PACU(10 min after entering PACU) and at the time of 4-,12-,24-and 48 hours after the operation,as well as the incidence of remedial analgesia and antiemetic within 48 hours after the operation were recorded. Results Compared with group G,the dosage of remifentanil was less,MAP of 1 min after skin incision was lower,the VAS pain scores in PACU and at the time of 4-and 12 hours after the surgery,the VAS of PONV score in PACU and 4-,12-and 24 h after the surgery and the rate of postoperative relief analgesia and antiemesis were lower in group G+B,and all the differences were significant( P< 0.05). Conclusion Ultrasound-guided GANB+ATNB can reduce the dosage of remifentanil during middle ear microsurgery,relieve the intra-operative hemodynamic changes and reduce patients’ demands for postoperative analgesia and antiemetic.

关 键 词：耳大神经阻滞 耳颞神经阻滞 中耳手术 多模式镇痛 低阿片化麻醉 

分 类 号：R614.4[医药卫生—麻醉学]