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颈浅丛神经阻滞可改善甲状腺切除术后的疼痛控制:一项随机对照试验。

Superficial cervical plexus blockade improves pain control after thyroidectomy: A randomized controlled trial.

机构信息

Departamento de Anestesia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.

Departamento de Cirurgia de Cabeca e Pescoco, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.

出版信息

Clinics (Sao Paulo). 2019;74:e605. doi: 10.6061/clinics/2019/e605. Epub 2019 Sep 16.

Abstract

OJECTIVES

The aim was to evaluate the ability of bilateral superficial cervical plexus blockade to control pain and to reduce the side effects of general anesthesia in patients submitted to thyroidectomy.

METHODS

In this randomized controlled trial, we prospectively studied 100 consecutive patients who underwent total thyroidectomy. The simple random patient sample was divided into two groups: 50 patients received general anesthesia alone (group 1 [G1]), and 50 patients received general anesthesia with bilateral superficial cervical plexus blockade (group 2 [G2]). Statistical analyses were performed, and a 5% significance level was adopted.

RESULTS

The mean arterial blood pressure and heart rate were 12% lower in G2 patients than in G1 patients 60 minutes after surgery (101 mmHg for G1 vs. 92.3 mmHg for G2; p<0.001). G2 patients reported less pain than G1 patients, and opioid consumption was lower in G2 patients than in G1 patients, not upon postanesthesia care unit arrival, but at 30 minutes (2% vs. 34%; p<0.001, respectively), 45 minutes (0% vs. 16%; p=0.006, respectively), and 4 hours postoperatively (6% vs. 20%; p=0.037, respectively). The incidence of nausea and vomiting was lower in G2 patients than in G1 patients from 45 minutes (0% vs. 16%; p=0.006, respectively) to 8 hours postoperatively (0% vs. 14%; p=0.012, respectively).

CONCLUSIONS

The present study demonstrated that the combination of bilateral superficial cervical plexus blockade with general anesthesia for thyroidectomy is feasible, safe, and effective for achieving pain control and improving patient outcomes.

摘要

目的

评估双侧颈浅丛神经阻滞在控制甲状腺切除术患者疼痛和减少全身麻醉副作用方面的能力。

方法

这是一项前瞻性随机对照试验,共纳入 100 例连续行甲状腺全切术的患者。单纯随机抽样患者分为两组:50 例接受单纯全身麻醉(G1 组),50 例接受全身麻醉联合双侧颈浅丛神经阻滞(G2 组)。进行统计学分析,采用 5%的显著性水平。

结果

与 G1 组相比,G2 组患者术后 60 分钟的平均动脉压和心率分别降低了 12%(G1 组 101mmHg,G2 组 92.3mmHg;p<0.001)。G2 组患者疼痛评分低于 G1 组,且 G2 组患者术后即刻(2%vs.34%;p<0.001)、30 分钟(0%vs.16%;p=0.006)、45 分钟(0%vs.16%;p=0.006)、4 小时(6%vs.20%;p=0.037)时的阿片类药物消耗量也低于 G1 组。从 45 分钟(0%vs.16%;p=0.006)到术后 8 小时(0%vs.14%;p=0.012),G2 组患者恶心呕吐的发生率也低于 G1 组。

结论

本研究表明,双侧颈浅丛神经阻滞联合全身麻醉用于甲状腺切除术是可行的、安全的,且能有效控制疼痛,改善患者预后。

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