超声引导胸椎旁阻滞对经皮肾镜术后镇痛的影响
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摘要
目的:探讨超声引导单点单次胸椎旁阻滞(ThPVB)对经皮肾镜碎石术(PCNL)后镇痛效果和吗啡消耗量的影响。方法:选择行择期PCNL患者50例,随机分ThPVB组(P组)和对照组(C组)。P组于术毕在Sonosite M-Turbo彩色超声诊断仪引导下,于T11胸椎旁间隙注入0.5%罗哌卡因(耐乐品)10 mL;C组不行胸椎旁阻滞。两组术后均使用吗啡自控镇痛泵,记录麻醉诱导前、术中和术后的心率(HR)、外周脉搏氧饱和度(SPO2)、呼吸频率(RR)和无创血压(BP),记录拔除气管导管后24 h内的NRS评分、RR、Ramsey镇静评分,同时记录拔除气管导管后24 h吗啡总消耗量、不良反应和患者满意度。结果:P组拔除气管导管后0.5 h、1 h、2 h、4 h、8 h、12 h和24 h的NRS评分分别为1.4±1.4、1.9±1.3、2.2±1.4、2.3±1.0、2.4±1.6、1.9±0.9、1.6±0.9,相同时间点静息NRS评分分别为0.3±0.7、0.7±0.9、0.9±1.0、1.1±0.9、1.0±1.0、0.6±0.7、0.4±0.6,低于C组(P<0.05或P<0.01)。P组拔管后24 h内各个时间点的Ramsay镇静评分与C组相比,差异无统计学意义(P>0.05)。P组术后24 h的吗啡总消耗量为(4.5±2.3)mg,C组为(9.2±4.9)mg(P<0.01)。P组、C组的患者"非常满意"度分别占80.0%和23.6%(P<0.05)。结论:ThPVB可以为接受PCNL手术的患者提供良好的术后镇痛,并提高患者的镇痛满意度。
Objective To investigate the effect of ultrasound-guided single-point single-dose thoracic paravertebral block(ThPVB) on analgesia effect and morphine consumption in patients undergoing percutaneous nephrolithotomy(PCNL). Methods 50 patients scheduled for elective percutaneous nephrolithotomy were randomized into ThPVB group( Group P) and Control group( Group C). After the procedure, in the group P, a single-shot ThPVB with 0.5% ropivacaine(Naropin) 10 ml was performed at the T11 thoracic paravertebral space under the guidance of Sonosite M-Turbo. ThPVB was not performed in group C. patients in both groups received patient-controlled analgesia service with morphine. Heart rate(HR), peripheral pulse oxygen saturation(SPO2),respiratory rate(RR) and noninvasive blood pressure(BP) before the anesthesia, during and after the procedure were recorded. The NRS score, RR, and Ramsey sedation score 24 h after tracheal extubation were recorded, as well as the total consumption of morphine(MC), adverse reactions, patient satisfaction(Level of Satisfaction,LOS). Results The movement NRS score of patients in group P was 1.4±1.4, 1.9±1.3, 2.2±1.4, 2.3±1.0,2.4±1.6, 1.9±0.9 and1.6±0.9, at 0.5 h, 1 h, 2 h, 4 h, 8 h, 12 h and 24 h after extubation respectively. The rest NRS score at the same time point was 0.3±0.7, 0.7±0.9, 0.9±1.0, 1.1± 0.9,1.0±1.0, 0.6±0.7 and0.4±0.6 respectively. Both movement and rest NRS scores in group P were lower than that of the group C(P<0.05 Or P<0.01). The Ramsay sedation score at each time point within 24 hours after extubation in group P was not signi?cantly different from the same time point in group C. The MC of 24 hours after operation in group P was(4.5±2.3) mg, which was less than that of group C(9.2±4.9) mg(P<0.001). The level "very satis?ed" accounted for 80% and 23.6% in Group P and Group C respectively. Conclusion For patients undergoing PCNL, ThPVB is effective in decreasing postoperative pain and can improve the postoperative satisfaction for patients.
Objective To investigate the effect of ultrasound-guided single-point single-dose thoracic paravertebral block(ThPVB) on analgesia effect and morphine consumption in patients undergoing percutaneous nephrolithotomy(PCNL). Methods 50 patients scheduled for elective percutaneous nephrolithotomy were randomized into ThPVB group( Group P) and Control group( Group C). After the procedure, in the group P, a single-shot ThPVB with 0.5% ropivacaine(Naropin) 10 ml was performed at the T11 thoracic paravertebral space under the guidance of Sonosite M-Turbo. ThPVB was not performed in group C. patients in both groups received patient-controlled analgesia service with morphine. Heart rate(HR), peripheral pulse oxygen saturation(SPO2),respiratory rate(RR) and noninvasive blood pressure(BP) before the anesthesia, during and after the procedure were recorded. The NRS score, RR, and Ramsey sedation score 24 h after tracheal extubation were recorded, as well as the total consumption of morphine(MC), adverse reactions, patient satisfaction(Level of Satisfaction,LOS). Results The movement NRS score of patients in group P was 1.4±1.4, 1.9±1.3, 2.2±1.4, 2.3±1.0,2.4±1.6, 1.9±0.9 and1.6±0.9, at 0.5 h, 1 h, 2 h, 4 h, 8 h, 12 h and 24 h after extubation respectively. The rest NRS score at the same time point was 0.3±0.7, 0.7±0.9, 0.9±1.0, 1.1± 0.9,1.0±1.0, 0.6±0.7 and0.4±0.6 respectively. Both movement and rest NRS scores in group P were lower than that of the group C(P<0.05 Or P<0.01). The Ramsay sedation score at each time point within 24 hours after extubation in group P was not signi?cantly different from the same time point in group C. The MC of 24 hours after operation in group P was(4.5±2.3) mg, which was less than that of group C(9.2±4.9) mg(P<0.001). The level "very satis?ed" accounted for 80% and 23.6% in Group P and Group C respectively. Conclusion For patients undergoing PCNL, ThPVB is effective in decreasing postoperative pain and can improve the postoperative satisfaction for patients.
引文
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[11]Albi-Feldzer A,Duceau B,Nguessom W,et al.A severe complication after ultrasound-guided thoracic paravertebral block for breast cancer surgery:total spinal anaesthesia:A case report[J].Eur J Anaesthesiol,2016,33(12):949-951.
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[13]Kaya FN,Turker G,Mogol EB,et al.Thoracic paravertebral block for video-assisted thoracoscopic surgery:single injection versus multiple injections[J].J Cardiothorac Vasc Anesth,2012,26(1):90-94.
[14]辜晓岚,何建华,顾连兵,等.超声引导胸椎旁神经阻滞对食管癌手术患者应激反应的影响[J].临床麻醉学杂志,2015,31(1):18-21.
[15]Moussa AA.Opioid saving strategy:bilateral single-site thoracic paravertebral block in right lobe donor hepatectomy[J].Middle East J Anaesthesiol,2008,19(4):789-801.
[16]Zhang B,Wang G,Liu X,et al.The Opioid-Sparing Effect of Perioperative Dexmedetomidine Combined with Oxycodone Infusion during Open Hepatectomy:A Randomized Controlled Trial[J].Front Pharmacol,2017,8:940.
[17]Copik M,Bialka S,Daszkiewicz A,et al.Thoracic paravertebral block for postoperative pain management after renal surgery:A r a n d o m i s e d c o n t r o l l e d t r i a l[J].E u r J A n a e s t h e s i o l,2017,34(9):596-601.
[18]Kairaluoma PM,Bachmann MS,Korpinen AK,et al.Singleinjection paravertebral block before general anesthesia enhances analgesia after breast cancer surgery with and without associated lymph node biopsy[J].Anesth Analg,2004,99(6):1837-1843.
[19]Tonosu J,Inanami H,Oka H,et al.Factors related to subjective satisfaction following microendoscopic foraminotomy for cervical radiculopathy[J].BMC Musculoskelet Disord,2018,19(1):30.
[20]Kaya FN,Turker G,Basagan-Mogol E,et al.Preoperative multiple-injection thoracic paravertebral blocks reduce postoperative pain and analgesic requirements after video-assisted thoracic surgery[J].J Cardiothorac Vasc Anesth,2006,20(5):639-643.
[2]Dalela D,Goel A,Singh P,et al.Renal capsular block:a novel method for performing percutaneous nephrolithotomy under local anesthesia[J].J Endourol,2004,18(6):544-6.
[3]White PF,Kehlet H,Neal JM,et al.The role of the anesthesiologist in fast-track surgery:from multimodal analgesia to perioperative medical care[J].Anesth Analg,2007,104(6):1380-96.
[4]Kaya FN,Turker G,Mogol EB,et al.Thoracic paravertebral block for video-assisted thoracoscopic surgery:single injection versus multiple injections[J].Cardiothorac Vasc Anesth,2012,26(1):90-4.
[5]Bondár A,Szucs S,Iohom G.Thoracic paravertebral blockade[J].Med Ultrason,2010,12(3):223-227.
[6]Klein SM,Bergh A,Steele SM,et al.Thoracic paravertebral block for breast surgery[J].Anesth Analg,2000,90(6):1402-1405.
[7]L?nnqvist PA,B?senberg AT.Anatomical dissections are not obsolete.Cadaver studies can still provide important information for regional anaesthesia[J].Eur J Anaesthesiol,2014,31(6):303-304.
[8]Cheema SP,Ilsley D,Richardson J,et al.A thermographic study of paravertebral analgesia[J].Anaesthesia,1995,50(2):118-121.
[9]Luyet C,Siegenthaler A,Szucs-Farkas Z,et al.The location of paravertebral catheters placed using the landmark technique[J].Anaesthesia,2012,67(12):1321-1326.
[10]Richardson J,L?nnqvist PA,Naja Z,et al.Bilateral thoracic paravertebral block:potential and practice[J].Br J Anaesth,2011,106(2):164-171.
[11]Albi-Feldzer A,Duceau B,Nguessom W,et al.A severe complication after ultrasound-guided thoracic paravertebral block for breast cancer surgery:total spinal anaesthesia:A case report[J].Eur J Anaesthesiol,2016,33(12):949-951.
[12]O Riain SC,Donnell BO,Cuffe T,et al.Thoracic paravertebral block using real-time ultrasound guidance[J].Anesth Analg,2010,110(1):248-251.
[13]Kaya FN,Turker G,Mogol EB,et al.Thoracic paravertebral block for video-assisted thoracoscopic surgery:single injection versus multiple injections[J].J Cardiothorac Vasc Anesth,2012,26(1):90-94.
[14]辜晓岚,何建华,顾连兵,等.超声引导胸椎旁神经阻滞对食管癌手术患者应激反应的影响[J].临床麻醉学杂志,2015,31(1):18-21.
[15]Moussa AA.Opioid saving strategy:bilateral single-site thoracic paravertebral block in right lobe donor hepatectomy[J].Middle East J Anaesthesiol,2008,19(4):789-801.
[16]Zhang B,Wang G,Liu X,et al.The Opioid-Sparing Effect of Perioperative Dexmedetomidine Combined with Oxycodone Infusion during Open Hepatectomy:A Randomized Controlled Trial[J].Front Pharmacol,2017,8:940.
[17]Copik M,Bialka S,Daszkiewicz A,et al.Thoracic paravertebral block for postoperative pain management after renal surgery:A r a n d o m i s e d c o n t r o l l e d t r i a l[J].E u r J A n a e s t h e s i o l,2017,34(9):596-601.
[18]Kairaluoma PM,Bachmann MS,Korpinen AK,et al.Singleinjection paravertebral block before general anesthesia enhances analgesia after breast cancer surgery with and without associated lymph node biopsy[J].Anesth Analg,2004,99(6):1837-1843.
[19]Tonosu J,Inanami H,Oka H,et al.Factors related to subjective satisfaction following microendoscopic foraminotomy for cervical radiculopathy[J].BMC Musculoskelet Disord,2018,19(1):30.
[20]Kaya FN,Turker G,Basagan-Mogol E,et al.Preoperative multiple-injection thoracic paravertebral blocks reduce postoperative pain and analgesic requirements after video-assisted thoracic surgery[J].J Cardiothorac Vasc Anesth,2006,20(5):639-643.