超声引导下前锯肌平面阻滞对乳房假体植入术后疼痛的影响
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摘要
目的探讨超声引导下前锯肌平面(serratus anterior plane, SAP)阻滞对乳房假体植入术患者术后疼痛的影响。方法选择拟全麻下行双侧乳房假体植入术女性患者50例,年龄18～40岁,BMI 18～24 kg/m~2,ASAⅠ或Ⅱ级,随机分为神经阻滞组(N组)和对照组(C组),每组25例。在常规麻醉诱导前,N组行超声引导下双侧SAP阻滞,每侧注射0.375%罗哌卡因20 ml;C组每侧SAP注射生理盐水20 ml。记录患者术后2、6、12和24 h静息状态下VAS评分、围术期阿片类药物用量、PCIA泵有效按压次数、补救镇痛次数;记录不良反应发生情况和患者满意度。结果与C组比较,N组术后2、6、12和24 h VAS评分明显降低,术中瑞芬太尼用量和术后24 h内舒芬太尼用量明显降低,术后PCIA泵有效按压次数和补救镇痛次数明显减少,患者满意度明显提高(P<0.05)。两组并发症发生率差异无统计学意义。结论超声引导下前锯肌平面阻滞可减轻乳房假体植入术患者术后疼痛。
Objective To investigate the effect of ultrasound-guided serratus anterior plane(SAP) block on postoperative pain in patients undergoing breast prosthesis implantation. Methods Fifty patients scheduled for breast prosthesis implantation under general anesthesia, aged 18-40 years, BMI 18-24 kg/m~2, falling into ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups(n = 25 each): SAP block group(group N) and control group(group C). Ultrasound-guided bilateral SAP block was performed before induction of anesthesia, and 0.375% ropivacaine 20 ml was injected bilaterally in group N, while the equal volume of normal saline was used instead in group C. The visual analogue scale(VAS) in resting state was evaluated at 2, 6, 12 and 24 h after surgery. Also, the perioperative opioid consumption, the numbers of PCIA pressing attempts and rescue analgesia, adverse effects and patients′ satisfaction degree within 24 h postoperatively were recorded. Results Compared to group C, the scores of VAS at postoperative 2, 6, 12 and 24 hand the perioperative consumption of opioid were significantly lower, the numbers of PCIA pressing attempts and rescue analgesia were decreased, while patients′ satisfaction degree was increased in group N(P < 0.05).There were no significant differences in adverse reactions between these two groups. Conclusion Ultrasound-guided SAP block reduces the postoperative pain in patients undergoing breast prosthesis implantation.
Objective To investigate the effect of ultrasound-guided serratus anterior plane(SAP) block on postoperative pain in patients undergoing breast prosthesis implantation. Methods Fifty patients scheduled for breast prosthesis implantation under general anesthesia, aged 18-40 years, BMI 18-24 kg/m~2, falling into ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups(n = 25 each): SAP block group(group N) and control group(group C). Ultrasound-guided bilateral SAP block was performed before induction of anesthesia, and 0.375% ropivacaine 20 ml was injected bilaterally in group N, while the equal volume of normal saline was used instead in group C. The visual analogue scale(VAS) in resting state was evaluated at 2, 6, 12 and 24 h after surgery. Also, the perioperative opioid consumption, the numbers of PCIA pressing attempts and rescue analgesia, adverse effects and patients′ satisfaction degree within 24 h postoperatively were recorded. Results Compared to group C, the scores of VAS at postoperative 2, 6, 12 and 24 hand the perioperative consumption of opioid were significantly lower, the numbers of PCIA pressing attempts and rescue analgesia were decreased, while patients′ satisfaction degree was increased in group N(P < 0.05).There were no significant differences in adverse reactions between these two groups. Conclusion Ultrasound-guided SAP block reduces the postoperative pain in patients undergoing breast prosthesis implantation.
引文
[1] Khalil AE,Abdallah NM, Bashandy GM, et al. Ultrasound guided serratusanterior plane block versus thoracic epidural analgesia for thoracotomy pain. J Cardiothorac Vasc Anesth, 2017, 31(1): 152-158.
[2] Kunhabdulla NP, Agarwal A, Gaur A, et al. Serratus anterior plane block for multiple rib fractures. Pain Physician, 2014, 17(5): E651-E653.
[3] Blanco R, Parras T, McDonnell JG, et al. Serratusplane block: a novel ultrasound-guided thoracic wall nerveblock. Anaesthesia, 2013, 68(11): 1107-1113.
[4] Mayes J, Davison E,Panahi P, et al. An anatomical evaluation of the serratus anterior plane block. Anaesthesia, 2016, 71(9): 1064-1069.
[5] Hards M, Harada A, Neville I, et al. The effect of serratus plane block performed underdirect vision on postoperative pain in breast surgery. J Clin Anesth, 2016, 34: 427-431.
[6] ?kmen K, Metin ?kmen B. Evaluation of the effect of serratus anterior plane block for pain treatment after video-assisted thoracoscopic surgery. Anaesth Crit Care Pain Med, 2018, 37(4): 349-353.
[7] 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. 临床麻醉学杂志, 2016, 32(12): 1173-1176.
[8] Pérez Herrero MA, López álvarez S, Fadrique Fuentes A, et al. Quality of postoperative recovery after breast surgery. General anaesthesia combined with paravertebral versus serratus-intercostal block. Rev Esp Anestesiol Reanim, 2016,63(10): 564-571.
[9] Kunigo T, Murouchi T, Yamamoto S, et al. Injection volume and anesthetic effect in serratus plane block. Reg Anesth Pain Med, 2017, 42(6): 737-740.
[2] Kunhabdulla NP, Agarwal A, Gaur A, et al. Serratus anterior plane block for multiple rib fractures. Pain Physician, 2014, 17(5): E651-E653.
[3] Blanco R, Parras T, McDonnell JG, et al. Serratusplane block: a novel ultrasound-guided thoracic wall nerveblock. Anaesthesia, 2013, 68(11): 1107-1113.
[4] Mayes J, Davison E,Panahi P, et al. An anatomical evaluation of the serratus anterior plane block. Anaesthesia, 2016, 71(9): 1064-1069.
[5] Hards M, Harada A, Neville I, et al. The effect of serratus plane block performed underdirect vision on postoperative pain in breast surgery. J Clin Anesth, 2016, 34: 427-431.
[6] ?kmen K, Metin ?kmen B. Evaluation of the effect of serratus anterior plane block for pain treatment after video-assisted thoracoscopic surgery. Anaesth Crit Care Pain Med, 2018, 37(4): 349-353.
[7] 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. 临床麻醉学杂志, 2016, 32(12): 1173-1176.
[8] Pérez Herrero MA, López álvarez S, Fadrique Fuentes A, et al. Quality of postoperative recovery after breast surgery. General anaesthesia combined with paravertebral versus serratus-intercostal block. Rev Esp Anestesiol Reanim, 2016,63(10): 564-571.
[9] Kunigo T, Murouchi T, Yamamoto S, et al. Injection volume and anesthetic effect in serratus plane block. Reg Anesth Pain Med, 2017, 42(6): 737-740.