Gong Jing, Yao Youxiu, Wang Yanbiao
Department of Anesthesiology, The 960th Hospital of the People's Liberation Army Joint Logistical Support Force, Jinan, Shandong, People's Republic of China.
Department of Anesthesiology, Peking University Third Hospital, Beijing, People's Republic of China.
Local Reg Anesth. 2021 Apr 23;14:75-83. doi: 10.2147/LRA.S299312. eCollection 2021.
The aim of this study is to evaluate the effect of ultrasound-guided bilateral cervical plexus block on general anesthesia, postoperative analgesia, and surgical outcomes in patients undergoing total parathyroidectomy with autotransplantation.
Forty-eight ASA III-IV patients with hyperparathyroidism secondary to renal failure were included: 24 patients received ultrasound-guided bilateral superficial and deep cervical plexus block combined with general anesthesia (group A), and 24 patients received general anesthesia alone (group B). Postoperative patient-controlled intravenous analgesia was provided with sufentanil 2 μg/kg. The primary outcome is the postoperative pain scores. Secondary outcomes include intraoperative remifentanil dosage, changes in hemodynamics, extubation time, and sufentanil consumption. Surgical outcomes regarding calcium, phosphorus and parathormone values were also noted.
The patients in group A required less remifentanil than group B (2.56±0.92mg vs 3.38±0.84mg, =0.002) and lower VAS scores at 1, 3, 10, 24, and 48h postoperatively ( < 0.001). While the systolic blood pressure in group A patients was significantly greater than that in group B at T3 (immediately after extubation, [138.33±11.36 vs 129.08±17.06 mmHg; =0.032]), heart rates in group A were lower than in group B at 1 min before induction (T1 [89.46 ± 9.14 vs 96.71±14.19, =0.042]) and 1 min after intubation (T2 [70.08 ± 5.35 vs 79.25 ± 11.81, =0.002]). The extubation time in group A was shorter than that in group B ( < 0.001). There was no difference in calcium, phosphorus and parathormone values, nor in sufentanil consumption between the groups.
Ultrasound-guided bilateral superficial and deep cervical plexus block combined with general anesthesia for TPTA is an effective strategy to improve anesthesia management and achieve better postoperative analgesia, and has no impact on surgical outcomes.
本研究旨在评估超声引导下双侧颈丛阻滞对接受甲状旁腺全切自体移植术患者的全身麻醉、术后镇痛及手术效果的影响。
纳入48例因肾衰竭继发甲状旁腺功能亢进的ASA III-IV级患者：24例患者接受超声引导下双侧颈浅丛和深丛阻滞联合全身麻醉（A组），24例患者仅接受全身麻醉（B组）。术后采用舒芬太尼2μg/kg进行患者自控静脉镇痛。主要结局指标为术后疼痛评分。次要结局指标包括术中瑞芬太尼用量、血流动力学变化、拔管时间及舒芬太尼消耗量。还记录了钙、磷和甲状旁腺激素值等手术结局指标。
A组患者所需瑞芬太尼少于B组（2.56±0.92mg对3.38±0.84mg，P=0.002），且术后1、3、10、24及48小时的视觉模拟评分（VAS）更低（P<0.001）。虽然A组患者在T3（拔管后即刻）时的收缩压显著高于B组（[138.33±11.36对129.08±17.06 mmHg；P=0.032]），但A组在诱导前1分钟（T1[89.46±9.14对96.71±14.19，P=0.042]）和插管后1分钟（T2[70.08±5.35对79.25±11.81，P=0.002]）时的心率低于B组。A组的拔管时间短于B组（P<0.001）。两组间钙、磷和甲状旁腺激素值以及舒芬太尼消耗量均无差异。
超声引导下双侧颈浅丛和深丛阻滞联合全身麻醉用于甲状旁腺全切自体移植术是改善麻醉管理及实现更好术后镇痛的有效策略，且对手术效果无影响。
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