胸椎旁神经阻滞在电视辅助胸腔镜手术中的应用：一项随机对照试验
[Application of thoracic paravertebral nerve block in video-assisted thoracosopic surgery: a randomized controlled trial].
作者信息
Zhang Bo, Liu Dan-Yan
机构信息
Department of Anesthesia, First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China. E-mail:
出版信息
Nan Fang Yi Ke Da Xue Xue Bao. 2016 Apr 20;37(4):460-464. doi: 10.3969/j.issn.1673-4254.2017.04.06.
OBJECTIVE
To investigate the effect of a single dose of ropivacaine combined with sufentanilfor thoracic paravertebral block (TPVB) on pain and enhanced recovery after surgery (ERAS) in patients undergoing video-assisted thoracosopic surgery.
METHODS
Sixty patients undergoing video-assisted thoracosopic surgery were randomly divided into three groups to receive intravenous combined general anesthesia (group C), a single dose of ropivacainefor thoracic paravertebral block before surgery combined with intravenous and general anesthesia(group T), or a single dose of ropivacaineand sufentanilfor thoracic paravertebral blockcombined with intravenous and general anesthesia (group T). None of the patients used postoperative analgesia pump, and tramadol hydrochoride injection (100 mg) was given in cases with NRS scores > 4 after the surgery. The data were recorded including analgesics used for nerve block before the operation, intravenous dosage of sufentanilduring operation, total dose of sufentanilused (intravenous+nerve block), intravenous remifentanil dose during operation, NRS scores at 4, 6, 24, 48 h after the surgery, rescue analgesia in the first postoperative 24 h after surgery, ICU stay and hospital stay after the surgery.
RESULTS
Compared with those in group C, the intravenous sufentanildose, total sufentanildose, intravenous remifentanildose during operation, NRS scores at 4 and 6, 24 h, and ICU stay and hospital stay after the surgery were significantly decreased in groups T and T (P<0.05). The total dose of opioids during the operation and NRS scores at 4 and 6 h were significantly lower in group T than in group T (P<0.05), but the total dose of sufentanil, ICU stay and hospital stay were simialr between the two groups.
CONCLUSION
A single dose of ropivacaine combined with sufentanilfor thoracic paravertebral blockbefore surgery can reduce the total dose opioids, produce the optimal analgesic effect, and promote postoperative recovery of the patients.
目的
探讨单剂量罗哌卡因联合舒芬太尼用于胸椎旁神经阻滞（TPVB）对电视辅助胸腔镜手术患者疼痛及术后加速康复（ERAS）的影响。
方法
将60例行电视辅助胸腔镜手术的患者随机分为三组，分别接受静脉复合全身麻醉（C组）、术前单剂量罗哌卡因胸椎旁神经阻滞联合静脉及全身麻醉（T组）、单剂量罗哌卡因联合舒芬太尼胸椎旁神经阻滞联合静脉及全身麻醉（T组）。所有患者均未使用术后镇痛泵，术后NRS评分>4分时给予盐酸曲马多注射液（100mg）。记录术前神经阻滞所用镇痛药、术中舒芬太尼静脉用量、舒芬太尼总用量（静脉+神经阻滞）、术中瑞芬太尼静脉用量、术后4、6、24、48h的NRS评分、术后24h内的补救镇痛、术后ICU停留时间及住院时间。
结果
与C组相比，T组和T组术中舒芬太尼静脉用量、舒芬太尼总用量、术中瑞芬太尼静脉用量、术后4、6、24h的NRS评分、术后ICU停留时间及住院时间均显著降低（P<0.05）。T组术中阿片类药物总用量及术后4、6h的NRS评分显著低于T组（P<0.05），但两组舒芬太尼总用量、ICU停留时间及住院时间相似。
结论
术前单剂量罗哌卡因联合舒芬太尼用于胸椎旁神经阻滞可减少阿片类药物总用量，产生最佳镇痛效果，促进患者术后恢复。
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