Wei Z, Lei G Y, Wu L L, Xi C H, Yin Y, Wang G Y
Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
Zhonghua Yi Xue Za Zhi. 2022 Aug 9;102(29):2278-2282. doi: 10.3760/cma.j.cn112137-20220513-01048.
To study the effect of ultrasonic-guided serratus plane block combined with pectoral nerve block Ⅰ on postoperative analgesia after radical mastectomy. A total of 30 patients, all female, aged [ ()] 53 (43, 62) years old, who underwent radical mastectomy in Beijing Tongren Hospital from May to August 2021 were selected. The patients were divided into two groups (=15 in each group) using a random number table: general anesthesia alone+patient controlled intravenous analgesia (PCIA) group (control group) and serratus plane block combined with pectoral nerve block Ⅰ before general anesthesia+PCIA group (combined group). Numerical rating scale (NRS) at rest in both groups were detected in the post anesthesia care unit (PACU) and 4, 8, 12, 24, 36 and 48 h after operation. The time of first pain, the time of first pressing of the automatic analgesic device after the operation, the dosage of remifentanil during operation, cumulative dosages of sufentanil at 24 h and 48 h postoperatively, and the incidence of adverse effects were all recorded. The NRS scores in combined group in the PACU and 4, 8, 12 and 24 h after surgery were (2.1±1.7), (1.7±1.5), (1.5±1.4), (1.5±1.3) and (1.7±1.3), respectively, while the NRS scores in control group at each time points were (4.5±2.0), (3.2±1.4), (2.7±0.9), (2.8±0.9) and (2.4±0.8), respectively, and the NRS scores in combined group were significantly lower than those in control group (all <0.05). The NRS scores in combined group at 36 and 48 h after surgery were (1.8±1.6) and (1.6±1.2), while the NRS scores in control group were (2.2±0.9) and (2.1±0.8), and the differences between the two groups were not statistically significant (both >0.05). The time of first pain and the time of the first pressing of the automatic analgesic device in combined group were (573±174) min and (962±313) min, which were significantly longer than those of control group [(13±6) min and (135±41) min] (both <0.05). The dosage of remifentanil during operation and cumulative dosage of sufentanil at 24 h postoperatively in combined group were (410±129) μg and (14±4) μg, which were lower than those in control group [(580±225) μg and (21±11) μg] (both <0.05). Cumulative dosage of sufentanil at 48 h postoperatively in combined group was (29±11) μg, while in control group was (36±14) μg, and the difference between the two groups was not statistically significant (=0.131). The incidence of postoperative dizziness in combined group was 6.7% (1/15), which was lower than that of control group [40.0% (6/15)] (=0.031). The incidence of nausea and pruritus was 6.7% (1/15) and 0 in combined group, while 20.0% (3/15) and 6.7% (1/15) in control group, with no statistical significance (both >0.05). Serratus plane block combined with pectoral nerve block Ⅰ can effectively relieve postoperative pain, decrease the need for opioids, and reduce the incidence of adverse effects.
研究超声引导下锯肌平面阻滞联合胸神经阻滞Ⅰ对乳腺癌根治术后镇痛的效果。选取2021年5月至8月在北京同仁医院行乳腺癌根治术的30例女性患者,年龄[()]53(43,62)岁。采用随机数字表法将患者分为两组(每组15例):单纯全身麻醉+患者自控静脉镇痛(PCIA)组(对照组)和全身麻醉前锯肌平面阻滞联合胸神经阻滞Ⅰ+PCIA组(联合组)。在麻醉后恢复室(PACU)及术后4、8、12、24、36和48 h检测两组患者静息时的数字评分量表(NRS)。记录首次疼痛时间、术后首次按压自控镇痛装置的时间、术中瑞芬太尼用量、术后24 h和48 h舒芬太尼累计用量及不良反应发生率。联合组在PACU及术后4、8、12和24 h的NRS评分分别为(2.1±1.7)、(1.7±1.5)、(1.5±1.4)、(1.5±1.3)和(1.7±1.3),而对照组各时间点的NRS评分分别为(4.5±2.0)、(3.2±1.4)、(2.7±0.9)、(2.8±0.9)和(2.4±0.8),联合组的NRS评分显著低于对照组(均P<0.05)。联合组术后36和48 h的NRS评分分别为(1.8±1.6)和(1.6±1.2),对照组分别为(2.2±0.9)和(2.1±0.8),两组差异无统计学意义(均P>0.05)。联合组首次疼痛时间和首次按压自控镇痛装置的时间分别为(573±174)min和(962±313)min,显著长于对照组[(13±6)min和(135±41)min](均P<0.05)。联合组术中瑞芬太尼用量及术后24 h舒芬太尼累计用量分别为(410± 129)μg和(14±4)μg,低于对照组[(580±225)μg和(21±11)μg](均P<0.05)。联合组术后48 h舒芬太尼累计用量为(29±11)μg,对照组为(36±14)μg,两组差异无统计学意义(P=0.131)。联合组术后头晕发生率为6.7%(1/15),低于对照组[40.0%(6/15)](P=0.031)。联合组恶心和瘙痒发生率分别为6.7%(1/15)和0,对照组分别为20.0%(3/15)和6.7%(1/15),差异无统计学意义(均P>0.05)。锯肌平面阻滞联合胸神经阻滞Ⅰ能有效缓解术后疼痛,减少阿片类药物用量,降低不良反应发生率。