超声引导下前锯肌平面复合腹直肌切口局部浸润在胆管结石开腹手术中的应用
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摘要
目的:探讨超声引导下前锯肌平面阻滞(serratus anterior plane block,SAPB)复合腹直肌切口局部浸润在胆管结石开腹手术中的临床应用效果。方法:40例择期行胆管结石开腹切除手术患者,随机分为观察组(R组)和对照组(C组),每组20例。R组手术结束关腹前给予腹直肌切口局部浸润,给予0.25%罗哌卡因20 ml,关腹后给予超声引导下前锯肌平面阻滞,给予0.25%罗哌卡因30 ml,接静脉镇痛泵。C组仅给予静脉镇痛泵。记录两组患者术后2、6、12、24、36、48 h视觉模拟评分(VAS)、术后48 h止痛泵按压次数及镇痛满意度;记录两组患者术后不良反应发生情况。结果:与C组相比,R组患者术后2、6、12、24 h VAS评分均低于C组,差异均有统计学意义(P<0.05),镇痛满意度更高(P<0.05);在术后0～2、2～6、6～12、12～24 h R组患者单次使用PCIA次数显著低于C组(P<0.05);两组术后恶心、呕吐、头晕、呼吸抑制发生率比较差异无统计学意义(P>0.05)。结论:超声引导下前锯肌平面复合腹直肌切口局部浸润联合静脉镇痛泵与单纯静脉镇痛泵相比,术后24 h镇痛效果好,患者满意度高,是一种值得推荐的麻醉镇痛方式。
Objective:To evaluate the effect of ultrasound-guided serratus anterior plane block(SAPB) combined with local anesthesia of rectus abdominis incision in patients undergoing choledocholithiasis laparotomy.Method:Forty patients scheduled for choledocholithiasis laparotomy were randomly divided into observation group(R group) and control group(C group),twenty patients in each group.The patients in group R were performed with local anesthesia of rectus abdominis before suturing the abdominal incision with 0.25% ropivacaine(20 ml),then ultrasound-guided SAPB applying 0.25% ropivacaine(30 ml) after the operation,combined with patient-controlled intravenous analgesia(PCIA).The group C was given PCIA only.The VAS score at 2,6,12,24,36,48 h and pressed times of patient-controlled analgesic pump with 48 h after operation and analgesic satisfaction after operation were recorded;The adverse reactions were assessed.Result:Compared with group C,VAS at 2,6,12,24 h in group R were significantly lower(P<0.05),analgesic satisfaction was better(P<0.05).The number of PCIA in group R was significantly less than that in group C during 0-2,2-6,6-12,12-24 h after operation(P<0.05).There were no significant difference of the rate of nausea,vomiting,dizziness and respiratory depression after operation(P>0.05).Conclusion:Ultrasound-guided SAPB in conjunction with local anesthesia of rectus abdominis combined with PCIA,make analgesic effect better more than 24 h postoperative,promote analgesic satisfaction,which is a safer and more effective method for the analgesia of choledocholithiasis laparotomy than PCIA only.
Objective:To evaluate the effect of ultrasound-guided serratus anterior plane block(SAPB) combined with local anesthesia of rectus abdominis incision in patients undergoing choledocholithiasis laparotomy.Method:Forty patients scheduled for choledocholithiasis laparotomy were randomly divided into observation group(R group) and control group(C group),twenty patients in each group.The patients in group R were performed with local anesthesia of rectus abdominis before suturing the abdominal incision with 0.25% ropivacaine(20 ml),then ultrasound-guided SAPB applying 0.25% ropivacaine(30 ml) after the operation,combined with patient-controlled intravenous analgesia(PCIA).The group C was given PCIA only.The VAS score at 2,6,12,24,36,48 h and pressed times of patient-controlled analgesic pump with 48 h after operation and analgesic satisfaction after operation were recorded;The adverse reactions were assessed.Result:Compared with group C,VAS at 2,6,12,24 h in group R were significantly lower(P<0.05),analgesic satisfaction was better(P<0.05).The number of PCIA in group R was significantly less than that in group C during 0-2,2-6,6-12,12-24 h after operation(P<0.05).There were no significant difference of the rate of nausea,vomiting,dizziness and respiratory depression after operation(P>0.05).Conclusion:Ultrasound-guided SAPB in conjunction with local anesthesia of rectus abdominis combined with PCIA,make analgesic effect better more than 24 h postoperative,promote analgesic satisfaction,which is a safer and more effective method for the analgesia of choledocholithiasis laparotomy than PCIA only.
引文
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[4]韩超,任鸿飞,周敏敏,等.超声引导下前锯肌平面阻滞对乳腺癌根治术患者术后镇痛的影响[J].临床麻醉学杂志,2016,32(12):1173-1176.
[5]侯雪琦,柴彬,林文新,等.超声引导前锯肌平面阻滞在胸腔镜肺叶切除术术后镇痛的效果[J].齐齐哈尔医学院学报,2018,39(10):1148-1150.
[6]柴彬,林文新,郑辉利,等.超声引导前锯肌平面复合腹直肌鞘阻滞在肝癌开腹手术中的应用[J].实用医学杂志,2018,34(2):339-340.
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[8]王虎,刘东昕,杜世新.肋间神经外侧皮支营养皮瓣的相关研究[J].临床和实验医学杂志,2008,7(5):38-39.
[9]董晓西,金周晟,夏芳芳,等.肋缘下腹横肌平面阻滞对胆道手术患者术后镇痛效果的影响[J].肝胆胰外科杂志,2011,23(2):120-122.
[10]饶竹青,董世阳,王灿琴,等.罗哌卡因切口浸润对肝癌患者术后镇痛及快速康复的影响[J].临床麻醉学杂志,2016,32(12):1169-1172.
[11]Piracha M M,Thorp S L,Puttanniah V,et al.“A tale of two planes”:deep versus superficial serratus plane block for postmastectomy pain syndrome[J].Reg Anesth Pain Med,2017,42(2):259-262.
[12]Kunigo T,Murouchi T,Yamamoto S,et al.Injection volume and anesthetic effect in serratus plane block[J].Reg Anesth Pain Med,2017,42(6):737-740.
[13]Elsharkawy H,Maniker R,Bolash R,et al.Rhomboid Intercostal and Subserratus Plane Block:A Cadaveric and Clinical Evaluation[J].Reg Anesth Pain Med,2018,43(7):745-751.
[2]中国加速康复外科专家组.中国加速康复外科围手术期管理专家共识(2016)[J].中华外科杂志,2016,54(6):413-418.
[3]Pérez Herrero M A,LópezáS,Fadrique F A,et al.Quality of postoperative recovery after breast surgery.General anaesthesia combined with paravertebral versus serratus-intercostal block[J].Revista Espanola De Anestesiologia Y Reanimacion,2016,63(10):564-571.
[4]韩超,任鸿飞,周敏敏,等.超声引导下前锯肌平面阻滞对乳腺癌根治术患者术后镇痛的影响[J].临床麻醉学杂志,2016,32(12):1173-1176.
[5]侯雪琦,柴彬,林文新,等.超声引导前锯肌平面阻滞在胸腔镜肺叶切除术术后镇痛的效果[J].齐齐哈尔医学院学报,2018,39(10):1148-1150.
[6]柴彬,林文新,郑辉利,等.超声引导前锯肌平面复合腹直肌鞘阻滞在肝癌开腹手术中的应用[J].实用医学杂志,2018,34(2):339-340.
[7]Kunigo T,Murouchi T,Yamamoto S,et al.Spread of injectate in ultrasound-guided serratus plane block:a cadaveric study[J].Ja Clinical Reports,2018,4(1):10.
[8]王虎,刘东昕,杜世新.肋间神经外侧皮支营养皮瓣的相关研究[J].临床和实验医学杂志,2008,7(5):38-39.
[9]董晓西,金周晟,夏芳芳,等.肋缘下腹横肌平面阻滞对胆道手术患者术后镇痛效果的影响[J].肝胆胰外科杂志,2011,23(2):120-122.
[10]饶竹青,董世阳,王灿琴,等.罗哌卡因切口浸润对肝癌患者术后镇痛及快速康复的影响[J].临床麻醉学杂志,2016,32(12):1169-1172.
[11]Piracha M M,Thorp S L,Puttanniah V,et al.“A tale of two planes”:deep versus superficial serratus plane block for postmastectomy pain syndrome[J].Reg Anesth Pain Med,2017,42(2):259-262.
[12]Kunigo T,Murouchi T,Yamamoto S,et al.Injection volume and anesthetic effect in serratus plane block[J].Reg Anesth Pain Med,2017,42(6):737-740.
[13]Elsharkawy H,Maniker R,Bolash R,et al.Rhomboid Intercostal and Subserratus Plane Block:A Cadaveric and Clinical Evaluation[J].Reg Anesth Pain Med,2018,43(7):745-751.