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评估颈浅丛阻滞用于头颈外科手术的镇痛效果:一项比较性随机对照研究。

Evaluating the Analgesic Efficacy of Superficial Cervical Plexus Block for Head and Neck Surgeries: A Comparative Randomized Control Study.

作者信息

Patel Himani, Shah Neha, Syed Afroza, Shah Panjari, Macwan Sharmy

机构信息

Department of Anaesthesia, Government Medical College, Sir Sayajirao General Hospital, Vadodara, IND.

出版信息

Cureus. 2023 May 21;15(5):e39303. doi: 10.7759/cureus.39303. eCollection 2023 May.

Abstract

INTRODUCTION

In the present study, the advantages of superficial cervical plexus block (SCPB) were evaluated using a landmark-guided method. Our primary aim was to evaluate the analgesic efficacy of SCPB in various head and neck surgeries by observing intra- and postoperative requirements of the total dose of the systemic analgesic, visual analog scale (VAS) score, and the total duration of analgesia; vital parameters and associated perioperative complications were also observed.

MATERIALS AND METHODS

Sample size was calculated using reference by taking the parameter pain score at 12 hours using MedCalc software v. 19.5.1 (MedCalc Software, Ostend, Belgium) with a mean difference of score 3±3.5 between two groups, 80% power, and 95% confidence interval (CI); the sample size for each group was 21. There were 30 patients in each group of ASA I, II, and III who were posted for mandibular, tympanomastoid and clavicular surgeries. Group A received general anaesthesia with systemic analgesia and Group B received general anaesthesia followed by SCPB with an injection of bupivacaine 0.25% 10ml on each side according to the site of surgery. VAS score, intra and postoperative analgesic requirement in 24 hours, time of first demand bolus, and peri-operative complications were noted.

RESULTS

Intraoperative fentanyl requirement for group A was 97.5±13.75 µg as compared to group B (70.16±13.09 µg), postoperative injection paracetamol requirement was also significantly higher in group A (2566.66±504 mg) as compared to group B (833.33±874.28 mg). The total duration of analgesia was significantly higher in Group B (1191.33±375.36 min) as compared to Group A (122.0±50.88 min) with a p-value <0.0001. No significant complications were noted in any patient.

CONCLUSION

SCPB provides better perioperative analgesia by decreasing intraoperative as well as postoperative systemic analgesic requirements and their associated side effects, with no significant perioperative complications in various head and neck region surgeries.

摘要

引言

在本研究中,采用体表标志引导法评估了颈浅丛阻滞(SCPB)的优势。我们的主要目的是通过观察全身镇痛药的术中及术后总剂量需求、视觉模拟评分(VAS)以及镇痛总时长,评估SCPB在各种头颈外科手术中的镇痛效果;同时还观察了生命体征参数及相关围手术期并发症。

材料与方法

使用MedCalc软件v. 19.5.1(MedCalc Software,比利时奥斯坦德)通过参考12小时疼痛评分来计算样本量,两组之间的平均评分差异为3±3.5,检验效能为80%,置信区间(CI)为95%;每组样本量为21例。每组有30例ASA I、II和III级患者,分别接受下颌、鼓室乳突和锁骨手术。A组接受全身麻醉并给予全身镇痛,B组接受全身麻醉后根据手术部位在双侧各注射10ml 0.25%布比卡因进行SCPB。记录VAS评分、24小时内的术中及术后镇痛需求、首次追加剂量时间以及围手术期并发症。

结果

A组术中芬太尼需求量为97.5±13.75μg,而B组为(70.16±13.09μg);A组术后对乙酰氨基酚注射需求量也显著高于B组(2566.66±504mg),而B组为(833.33±874.28mg)。B组的镇痛总时长(1191.33±375.36分钟)显著长于A组(122.0±50.88分钟),p值<0.0001。未观察到任何患者出现明显并发症。

结论

SCPB通过降低术中及术后全身镇痛药物需求及其相关副作用,提供了更好的围手术期镇痛效果,在各种头颈区域手术中无明显围手术期并发症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9919/10281613/196660e63c8e/cureus-0015-00000039303-i01.jpg

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