持续Ⅱ型胸神经阻滞与静脉自控镇痛用于乳腺癌改良根治术后镇痛效果比较
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摘要
目的比较持续Ⅱ型胸神经(PECSⅡ)阻滞与静脉自控镇痛用于乳腺癌改良根治术后镇痛的效果及安全性。方法选择行乳腺癌改良根治术的女性患者80例,采用随机数字表法分为持续PECSⅡ阻滞组(P组)和静脉自控镇痛组(V组),每组40例。两组患者均在全身麻醉下完成手术。P组采用局部镇痛装置,手术医生于缝合皮瓣前在PECSⅡ阻滞部位放置一根滴注导管,输注0.25%罗哌卡因2.0ml/h;V组采用静脉电子输液泵,输注舒芬太尼2.0μg/h。记录两组患者术后1、4、12、24、48h时静息状态下的视觉模拟评分(VAS)及术后补救镇痛例数;观察并记录两组患者术后恶心、呕吐、头晕、嗜睡、呼吸困难及创面积液等情况。结果 P组术后1、4h静息状态下VAS评分低于V组,差异均有统计学意义(均P<0.05);V组术后48h内补救镇痛例数、头晕、嗜睡发生率高于P组,差异均有统计学意义(均P<0.05);两组创面积液发生率比较,差异无统计学意义(P>0.05)。结论与静脉自控镇痛相比,持续PECSⅡ阻滞用于乳腺癌改良根治术后镇痛效果确切,降低了术后阿片类药物的使用率及不良反应的发生率,是一种安全有效的镇痛方法。
Objective To compare the efficacy and safety of continuous PECS Ⅱ block and patient-controlled intravenous analgesia(PCIA) in postoperative analgesia after modified radical mastectomy. Methods Eighty patients with unilateral breast cancer undergoing modified radical mastectomy were randomly divided into continuous PECSⅡ block group(group P) and PCIA group(group V)with 40 cases in each. The patients in both groups were operated under combined intravenous and inhaling anesthesia. In group P, before suturing the flap a drip catheter was placed between pectoralis minor and serratus anterior muscle and 0.25% ropivacaine was infused with a dose of 2.0 ml/h. In group V, the patients underwent PCIA with sufentanil with a dose of 2.0μg/h. The visual analogue score(VAS) at 1, 4, 12,24 and 48 h after operation and the number of postoperative rescue analgesia cases were recorded. Adverse reactions including postoperative nausea and vomiting(PONV), vertigo, drowsiness, dyspnea and wound effusion were observed and recorded. Results There were no significant differences in general condition, operation type and operation time between two groups(P >0.05). The VAS score of group P was significantly lower than that of group V at 1 and 4 h after operation(P<0.05). The cases of postoperative remedial analgesia and the incidence of vertigo and drowsiness in group V were more than those in group P(P<0.05). There was no significant difference in wound effusion between two groups(P >0.05). Conclusion Compared with patient-controlled intravenous analgesia, continuous PECSⅡ block is more effective in postoperative analgesia for breast cancer patients with modified radical mastectomy, which also can reduce postoperative opioid use and adverse reactions.
Objective To compare the efficacy and safety of continuous PECS Ⅱ block and patient-controlled intravenous analgesia(PCIA) in postoperative analgesia after modified radical mastectomy. Methods Eighty patients with unilateral breast cancer undergoing modified radical mastectomy were randomly divided into continuous PECSⅡ block group(group P) and PCIA group(group V)with 40 cases in each. The patients in both groups were operated under combined intravenous and inhaling anesthesia. In group P, before suturing the flap a drip catheter was placed between pectoralis minor and serratus anterior muscle and 0.25% ropivacaine was infused with a dose of 2.0 ml/h. In group V, the patients underwent PCIA with sufentanil with a dose of 2.0μg/h. The visual analogue score(VAS) at 1, 4, 12,24 and 48 h after operation and the number of postoperative rescue analgesia cases were recorded. Adverse reactions including postoperative nausea and vomiting(PONV), vertigo, drowsiness, dyspnea and wound effusion were observed and recorded. Results There were no significant differences in general condition, operation type and operation time between two groups(P >0.05). The VAS score of group P was significantly lower than that of group V at 1 and 4 h after operation(P<0.05). The cases of postoperative remedial analgesia and the incidence of vertigo and drowsiness in group V were more than those in group P(P<0.05). There was no significant difference in wound effusion between two groups(P >0.05). Conclusion Compared with patient-controlled intravenous analgesia, continuous PECSⅡ block is more effective in postoperative analgesia for breast cancer patients with modified radical mastectomy, which also can reduce postoperative opioid use and adverse reactions.
引文
[1]中华医学会整形外科学分会乳房专业学组.硅胶乳房假体隆乳术临床技术指南[J].中华整形外科杂志,2013,29(1):1-4.
[2]Poleshuck EL,Katz J,Andrus CH,et al.Risk factors for chronic pain following breast cancer surgery:a prospective study[J].JPain,2006,7(9):626-634.
[3]O'Scanaill P,Keane S,Wall V,et al.Single-shot pectoral plane(PECs I and PECs II)blocks versus continuous local anaesthetic infusion analgesia or both after non-ambulatory breast-cancer surgery:a prospective,randomised,double-blind trial[J].Br JAnaesth,2018,120:846-853.
[4]Kulhari S,Bharti N,Bala I,et al.Efficacy of pectoral nerve block versus thoracic paravertebral block for postoperative analgesia after radical mastectomy:a randomized controlled trial[J].Br JAnaesth,2016,117:382-386.
[5]李渭敏,王汉兵,熊艳峰,等.胸壁神经阻滞在乳腺区段切除术麻醉中的应用[J].广东医学,2018,39:126-128.
[6]王宏伟,陶红蕾,管婷.超声引导下胸部神经阻滞用于乳腺癌根治术后疼痛的效果观察[J].浙江医学,2018,40(12):1358-1360.
[7]Lennon FE,Moss J,Singleton PA.Theμ-opioid receptor in cancer progression:is there a direct effect?[J].Anesthesiology,2012,116(4):940-945.
[8]申乐,黄宇光.规范化术后多模式镇痛治疗对加速腹盆部手术后康复的意义[J].中国医学科学院学报,2016,38(4):458-463.
[9]Sarhadi NS,Shaw DJ,Lee FD,et al.An anatomical study of the nerve supply of the breast,including the nipple and areola[J].Br JPlast Surg,1996,49(3):156-164.
[10]Blanco R,Fajardo M,Parras MT.Ultrasound description of PECS II(modified PECS I):a novel approach to breast surgery[J].Rev Esp Anestesiol Reanim,2012,59(9):470-475.
[11]Ohgoshi Y,Yokozuka M,Terajima K.Serratus-Intercostal Plane Block for Brest Surgery[J].Masui,2015,64(6):610-614.
[2]Poleshuck EL,Katz J,Andrus CH,et al.Risk factors for chronic pain following breast cancer surgery:a prospective study[J].JPain,2006,7(9):626-634.
[3]O'Scanaill P,Keane S,Wall V,et al.Single-shot pectoral plane(PECs I and PECs II)blocks versus continuous local anaesthetic infusion analgesia or both after non-ambulatory breast-cancer surgery:a prospective,randomised,double-blind trial[J].Br JAnaesth,2018,120:846-853.
[4]Kulhari S,Bharti N,Bala I,et al.Efficacy of pectoral nerve block versus thoracic paravertebral block for postoperative analgesia after radical mastectomy:a randomized controlled trial[J].Br JAnaesth,2016,117:382-386.
[5]李渭敏,王汉兵,熊艳峰,等.胸壁神经阻滞在乳腺区段切除术麻醉中的应用[J].广东医学,2018,39:126-128.
[6]王宏伟,陶红蕾,管婷.超声引导下胸部神经阻滞用于乳腺癌根治术后疼痛的效果观察[J].浙江医学,2018,40(12):1358-1360.
[7]Lennon FE,Moss J,Singleton PA.Theμ-opioid receptor in cancer progression:is there a direct effect?[J].Anesthesiology,2012,116(4):940-945.
[8]申乐,黄宇光.规范化术后多模式镇痛治疗对加速腹盆部手术后康复的意义[J].中国医学科学院学报,2016,38(4):458-463.
[9]Sarhadi NS,Shaw DJ,Lee FD,et al.An anatomical study of the nerve supply of the breast,including the nipple and areola[J].Br JPlast Surg,1996,49(3):156-164.
[10]Blanco R,Fajardo M,Parras MT.Ultrasound description of PECS II(modified PECS I):a novel approach to breast surgery[J].Rev Esp Anestesiol Reanim,2012,59(9):470-475.
[11]Ohgoshi Y,Yokozuka M,Terajima K.Serratus-Intercostal Plane Block for Brest Surgery[J].Masui,2015,64(6):610-614.