文章摘要
超声引导下胸神经阻滞和胸椎旁神经阻滞用于乳腺癌根治术后镇痛效果的比较
Efficacy of ultrasound-guided pectoral nerve block versus thoracic paravertebral block for postoperative analgesia after radical mastectomy
  
DOI：10.12089/jca.2018.02.005
中文关键词: 术后镇痛  胸神经阻滞  椎旁神经阻滞  乳腺癌改良根治术
英文关键词: Postoperative analgesia  Pectoral nerve block  Paravertebral nerve block  Modified radical mastectomy
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作者单位E-mail
靳红绪 053000,河北省衡水市, 河北医科大学附属哈励逊国际和平医院麻醉科 jinhongxu998@163.com 
张同军 053000,河北省衡水市, 河北医科大学附属哈励逊国际和平医院麻醉科  
孙学飞 053000,河北省衡水市, 河北医科大学附属哈励逊国际和平医院麻醉科  
王忠义 053000,河北省衡水市, 河北医科大学附属哈励逊国际和平医院麻醉科  
王福朝 053000,河北省衡水市, 河北医科大学附属哈励逊国际和平医院麻醉科  
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中文摘要:
      目的 比较超声引导下胸神经Ⅱ(pectoral nerves Ⅱ, Pecs Ⅱ)阻滞和胸椎旁神经(thoracic paravertebral nerve, TPVN)阻滞在乳腺癌根治术后的镇痛效果。方法 择期行乳腺癌根治术的女性患者80例, 年龄40～65岁, ASA Ⅰ或Ⅱ级, 采用随机数字表法将之分为两组, 每组40例。P组于全麻诱导前在超声引导下用0.5%罗哌卡因25 ml行Pecs Ⅱ阻滞;T组则在超声引导下行TPVN阻滞, 给予同等剂量和浓度的罗哌卡因。所有患者神经阻滞完成后观察30 min, 采用针刺法记录痛觉较对侧减退的节段数。所有患者术后均给予PCIA。记录术后镇痛持续时间和术后24 h内舒芬太尼使用量, 以及术后并发症的发生情况。结果 P组术后镇痛持续时间明显长于T组［(326.5±47.8)min vs (201.4±34.5)min, P＜0.01］。P组术后24 h舒芬太尼使用量明显少于T组［(6.9±1.2)μg vs (10.7±1.9)μg, P＜0.01］。P组阻滞皮区达T2的患者明显多于T组［35例(87.6%) vs 9例(22.5%), P＜0.05］。两组均未出现术后并发症。结论 超声引导下Pecs Ⅱ阻滞与TPVN阻滞均可安全可靠地用于乳腺癌改良根治术患者, 但Pecs Ⅱ阻滞效果更为完善和持久。
英文摘要:
      Objective To compare the efficacy and safety of ultrasound-guided pectoral nerves Ⅱ (Pecs Ⅱ) block with thoracic paravertebral nerve (TPVN) block for postoperative analgesia after modified radical mastectomy. Methods Eighty female patients scheduled for radical mastectomy, aged 40-65 years, ASA physical status Ⅰ or Ⅱ, were randomly divided into 2 groups using a random number table method (n=40 each): the patients in group T received TPVN block, whereas the patients in group P received Pecs Ⅱ block. Both the groups received 0.5% ropivacaine 25 ml. The blocks were performed under all aseptic precautions in the preoperating room 30 min before surgery. The total number of dermatomes that had less pain to pin prick compared with opposite side were noted. All patients were observed for 30 min after performing the block. The patients were received patient-controlled intravenous analgesia (PCIA). The duration of analgesia and total analgesic consumption in 24 h after surgery were recorded. Adverse effects were recorded between the two groups. Results The duration of analgesia in group P was significantly prolonged than group T ［(326.5±47.8) min vs (201.4±34.5) min, P＜0.01］. The 24 h sufentanil consumption were also decreased in group P ［(6.9±1.2) μg vs (10.7±1.9) μg, P＜0.01］. T2 dermatomal spread were significantly increased in group P ［35 (87.6%) cases vs 9 (22.5%) cases, P＜0.05］. No complication was recorded. Conclusion Ultrasound-guided Pecs Ⅱ block and TPVN provided safe and effective anesthesia in patients undergoing modified radical mastectomy, but the effect of Pecs Ⅱ block were more satisfied and persistent.
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