超声引导下菱形肋间神经阻滞在乳腺癌手术术后镇痛中的评价：一项前瞻性、随机对照试验。
Evaluation of ultrasound-guided rhomboid intercostal nerve block for postoperative analgesia in breast cancer surgery: a prospective, randomized controlled trial.
机构信息
Anesthesiology, Muğla Sıtkı Koçman University, Muğla, Turkey
Anesthesiology, Muğla Sıtkı Koçman University, Muğla, Turkey.
出版信息
Reg Anesth Pain Med. 2020 Apr;45(4):277-282. doi: 10.1136/rapm-2019-101114. Epub 2020 Feb 19.
BACKGROUND AND OBJECTIVES
Mastectomy has many potential sources of pain. Rhomboid intercostal block (RIB) is a recently described plane block. The primary hypothesis of the study is that ultrasound-guided RIB combined with general anesthesia would accelerate global quality of recovery scores of patients following mastectomy surgery. Secondary hypothesis is that RIB would reduce postoperative opioid consumption, pain scores, and the need for rescue analgesia.
METHODS
Patients aged between 18 and 70 years, with American Society of Anesthesiologists physical status I-II and scheduled for an elective unilateral modified radical mastectomy surgery with axillary lymph node dissection were enrolled to the study. Following endotracheal intubation, patients were randomly allocated into two groups. Patients in the first group (group R) received ultrasound-guided RIB with 30 mL 0.25% bupivacaine. In the control group (group C), no block intervention was applied. All patients received intravenous dexamethasone 8 mg, dexketoprofen trometamol 50 mg intraoperatively and tramadol 1 mg/kg 30 min before the end of surgery for postoperative analgesia. All patients received intravenous morphine patient-controlled analgesia device at the arrival to the recovery room.
RESULTS
The descriptive variables of the patients were comparable between group R and group C. Mean quality of recovery-40 score at 24 hours was 164.8±3.9 in group R and 153.5±5.2 in group C (mean difference 11.4 (95% CI 8.8 to 13.9; p<0.001). At 24th hour, median morphine consumption was 5 mg (IQR 4-7 mg) in group R and 10 mg (IQR 8-13 mg) in group C, p<0.001. Intraoperative fentanyl administration, pain scores and the need for rescue postoperative analgesia was similar between groups.
CONCLUSIONS
In the current study, ultrasound-guided RIB promoted enhanced recovery and decreased opioid consumption after mastectomy surgery.
TRIAL REGISTRATION NUMBER
ACTRN12619000879167.
背景与目的
乳房切除术有许多潜在的疼痛源。菱形肋间阻滞（RIB）是一种最近描述的平面阻滞。该研究的主要假设是，超声引导的 RIB 联合全身麻醉将加速乳房切除术患者的整体恢复质量评分。次要假设是 RIB 将减少术后阿片类药物的消耗、疼痛评分和对抢救性镇痛的需求。
方法
纳入年龄在 18 至 70 岁之间、美国麻醉医师协会身体状况 I-II 级并计划接受单侧改良根治性乳房切除术和腋窝淋巴结清扫术的患者。在气管插管后，患者被随机分配到两组。第一组（R 组）患者接受超声引导的 RIB，注入 30ml 0.25%布比卡因。在对照组（C 组）中，不应用阻滞干预。所有患者在手术期间接受静脉注射地塞米松 8mg、右酮洛芬托美丁 50mg，手术结束前 30min 给予曲马多 1mg/kg 用于术后镇痛。所有患者到达恢复室时均给予静脉注射吗啡患者自控镇痛装置。
结果
R 组和 C 组患者的描述性变量相似。R 组 24 小时时的平均恢复质量-40 评分（164.8±3.9）高于 C 组（153.5±5.2）（平均差异 11.4[95%CI 8.8 至 13.9;p<0.001）。在 24 小时时，R 组吗啡消耗量中位数为 5mg（IQR 4-7mg），C 组为 10mg（IQR 8-13mg），p<0.001。两组术中芬太尼给药、疼痛评分和抢救性术后镇痛需求相似。
结论
在当前研究中，超声引导的 RIB 促进了乳房切除术患者的加速康复和减少阿片类药物的消耗。
试验注册号
ACTRN12619000879167。
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