膈神经阻滞对开胸术后术侧肩部疼痛的影响
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摘要
目的观察膈神经阻滞对开胸术后术侧肩部疼痛的影响。方法择期全麻下肺叶切除术患者70例,随机数字法分为两组:罗哌卡因组(R组)和对照组(C组),关闭胸腔前进行膈神经阻滞,分别给予0.25%罗哌卡因8ml(R组)或生理盐水8ml(C组)。术毕均行PCIA。记录术后2、4、8、12、24和48hVAS疼痛评分,术后术侧肩痛情况,术后24h内舒芬太尼的使用量、需补救镇痛药情况。结果与C组比较,R组术后术侧肩痛例数明显减少,术后2、4和8hVAS评分明显降低,术后24h内舒芬太尼总用量明显减少(P<0.05)。结论膈神经阻滞可以降低术后术侧肩痛的发生率。
Objective To evaluate the effects of phrenic nerve infiltration on ipsilateral shoulder pain in thoracotomy patients.Methods Seventy patients undergoing lung resection were randomly allocated into two groups.Before closing the chest,patients received infiltration of the ipsilateral phrenic nerve with saline 8ml(group C)and ropivacaine 0.25% 8ml(group R).All patients received patient-controlled intravenous analgesia(PCIA)after operation.A blinded observer recorded VAS scores of pain and the incidence of ipsilateral shoulder pain at 2h,4h,8h,12 h,24hand 48 hafter surgery.Sufentanil consumption during the first 24 hafter surgery was also recorded.Results The incidence of ipsilateral shoulder pain in group R was decreased during the first 8hafter surgery(P<0.05).VAS scores at 2,4,8hafter surgery were lower in group R than in group C(P<0.05).Compared with group C,sufentanil consumption in group R declined(P<0.05).Conclusion Phrenic nerve infiltration with ropivacaine reduced the incidence of ipsilateral shoulder pain during the first 8h after open lung resection.
Objective To evaluate the effects of phrenic nerve infiltration on ipsilateral shoulder pain in thoracotomy patients.Methods Seventy patients undergoing lung resection were randomly allocated into two groups.Before closing the chest,patients received infiltration of the ipsilateral phrenic nerve with saline 8ml(group C)and ropivacaine 0.25% 8ml(group R).All patients received patient-controlled intravenous analgesia(PCIA)after operation.A blinded observer recorded VAS scores of pain and the incidence of ipsilateral shoulder pain at 2h,4h,8h,12 h,24hand 48 hafter surgery.Sufentanil consumption during the first 24 hafter surgery was also recorded.Results The incidence of ipsilateral shoulder pain in group R was decreased during the first 8hafter surgery(P<0.05).VAS scores at 2,4,8hafter surgery were lower in group R than in group C(P<0.05).Compared with group C,sufentanil consumption in group R declined(P<0.05).Conclusion Phrenic nerve infiltration with ropivacaine reduced the incidence of ipsilateral shoulder pain during the first 8h after open lung resection.
引文
[1]徐守才,扈志多,陈红,等.不同自控静脉镇痛方案在开胸术后镇痛效果的观察.临床麻醉学杂志,2014,30(7):679-681.
[2]Tan N,Agnew NM,Scawn ND,et al.Suprascapular nerve block for ipsilateral shoulder pain after thoracotomy with thoracic epidural analgesia:a double-blind comparison of 0.5%bupivacaine and 0.9%saline.Anesth Analg,2002,94(1):199-202.
[3]Martinez-Barenys C,Busquets J,de Castro PE,et al.Randomized double-blind comparison of phrenic nerve infiltration and suprascapular nerve block for ipsilateral shoulder pain after thoracic surgery.Eur J Cardiothorac Surg,2011,40(1):106-112.
[4]Pennefather SH,Akrofi ME,Kendall JB,et al.Double-blind comparison of intrapleural saline and 0.25%bupivacaine for ipsilateral shoulder pain after thoracotomy in patients receiving thoracic epidural analgesia.Br J Anaesth,2005,94(2):234-238.
[5]Barak M,Ziser A,Katz Y.Thoracic epidural local anesthetics are ineffective in alleviating post-thoracotomy ipsilateral shoulder pain.J Cardiothorac Vasc Anesth,2004,18(4):458-460.
[6]安刚,薛富善.现代麻醉学技术.北京:科学技术文献出版社,2001:1235-1236.
[7]Mac TB,Girard F,Chouinard P,et al.Acetaminophen decreases early post-thoracotomy ipsilateral shoulder pain in patients with thoracic epidural analgesia:a double-blind placebo-controlled study.J Cardiothorac Vasc Anesth,2005,19(4):475-478.
[8]Scawn ND,Pennefather SH,Soorae A,et al.Ipsilateral shoulder pain after thoracotomy with epidural analgesia:the influence of phrenic nerve infiltration with lidocaine.Anesth Analg,2001,93(2):260-264.
[9]Barak M,Iaroshevski D,Poppa E,et al.Low-volume interscalene brachial plexus block for post-thoracotomy shoulder pain.J Cardiothorac Vasc Anesth,2007,21(4):554-557.
[10]Ohmori A,Iranami H,Fujii K,et al.Myofascial involvement of supra-and infraspinatus muscles contributes to ipsilateral shoulder pain after muscle-sparing thoracotomy and video-assisted thoracic surgery.J Cardiothorac Vasc Anesth,2013,27(6):1310-1314.
[2]Tan N,Agnew NM,Scawn ND,et al.Suprascapular nerve block for ipsilateral shoulder pain after thoracotomy with thoracic epidural analgesia:a double-blind comparison of 0.5%bupivacaine and 0.9%saline.Anesth Analg,2002,94(1):199-202.
[3]Martinez-Barenys C,Busquets J,de Castro PE,et al.Randomized double-blind comparison of phrenic nerve infiltration and suprascapular nerve block for ipsilateral shoulder pain after thoracic surgery.Eur J Cardiothorac Surg,2011,40(1):106-112.
[4]Pennefather SH,Akrofi ME,Kendall JB,et al.Double-blind comparison of intrapleural saline and 0.25%bupivacaine for ipsilateral shoulder pain after thoracotomy in patients receiving thoracic epidural analgesia.Br J Anaesth,2005,94(2):234-238.
[5]Barak M,Ziser A,Katz Y.Thoracic epidural local anesthetics are ineffective in alleviating post-thoracotomy ipsilateral shoulder pain.J Cardiothorac Vasc Anesth,2004,18(4):458-460.
[6]安刚,薛富善.现代麻醉学技术.北京:科学技术文献出版社,2001:1235-1236.
[7]Mac TB,Girard F,Chouinard P,et al.Acetaminophen decreases early post-thoracotomy ipsilateral shoulder pain in patients with thoracic epidural analgesia:a double-blind placebo-controlled study.J Cardiothorac Vasc Anesth,2005,19(4):475-478.
[8]Scawn ND,Pennefather SH,Soorae A,et al.Ipsilateral shoulder pain after thoracotomy with epidural analgesia:the influence of phrenic nerve infiltration with lidocaine.Anesth Analg,2001,93(2):260-264.
[9]Barak M,Iaroshevski D,Poppa E,et al.Low-volume interscalene brachial plexus block for post-thoracotomy shoulder pain.J Cardiothorac Vasc Anesth,2007,21(4):554-557.
[10]Ohmori A,Iranami H,Fujii K,et al.Myofascial involvement of supra-and infraspinatus muscles contributes to ipsilateral shoulder pain after muscle-sparing thoracotomy and video-assisted thoracic surgery.J Cardiothorac Vasc Anesth,2013,27(6):1310-1314.