摘要
目的研究脂质体布比卡因与盐酸布比卡因在超声引导下胸神经(pectoral nerves,PECS)阻滞用于乳腺全切术后的镇痛效果及不良反应发生率。方法择期行乳腺癌单侧乳腺全切术女性患者129例,随机分为空白对照组(C组)、盐酸布比卡因组(B组)和脂质体布比卡因组(LB组),于术前在超声引导下行术侧胸神经Ⅰ+Ⅱ阻滞(PecsⅠ+Ⅱ),LB组266 mg(20 mL)脂质体布比卡因溶于0.9%生理盐水至30 mL,B组0.5%盐酸布比卡因30 mL,C组0.9%生理盐水30 mL,在超声引导下分别于胸大肌和胸小肌之间(PecsⅠ型)注射局麻药液10 mL、胸小肌和前锯肌之间(PecsⅡ型)注射局麻药液20 mL,随后行静脉全麻诱导气管插管,静吸复合麻醉维持,术后清醒拔管后送麻醉后恢复室(PACU),评估记录在PACU(0 h),术后4、12、24、48、72 h的静息及活动疼痛数字评分法(NRS),术后首次使用镇痛药物的时间,术后72 h内阿片类药物累计使用量,术后恶心、呕吐的发生率,以及住院天数(length of stay,LOS)。结果NRS评分于PACU 0 h,术后4、12、48、72 h,LB组与B组无差别(P>0.05),24 h时LB组低于B组(P<0.05),二者均明显低于C组(P<0.05);术后首次使用镇痛药物的时间B组短于LB组(P<0.05),C组首次使用镇痛药时间明显短于B组和LB组(P<0.05);术后72 h内阿片类药物的累计使用量LB组小于B组(P<0.05),C组则显著高于LB组和B组(P<0.05);3组患者术后恶心、呕吐发生率,B组高于LB组(P<0.05),C组最高(P<0.05);3组住院时间无差别(P>0.05)。结论超声引导下PECS阻滞注射脂质体布比卡因可在乳腺全切术后72 h内提供较好的镇痛效果,其镇痛效果与盐酸布比卡因相当,但使用脂质体布比卡因可减少术后阿片药物使用量,降低恶心呕吐发生率。
Objective To investigate the analgesia effect and incidence of adverse reactions of ultrasound guided PECS blockade with liposome bupivacaine and bupivacaine hydrochloride after total mammectomy.Methods A total of 129 breast cancer women that underwent elective unilateral mammectomy were randomly divided into control group(group C),bupipivacaine hydrochloride group(group B)and liposome bupivacaine group(LB group).Before the operation,the pectoral nervesⅠ+Ⅱblock(PECSⅠ+Ⅱ)was performed under ultrasound guidance.In LB group,266 mg liposomal bupivacaine(20 mL)dissolved in 0.9%saline to 30 mL was used;30 mL 0.5%bupipivacaine hydrochloride in group B and 30 mL 0.9%saline in group C.Under the guidance of ultrasound,10 mL of local anesthetic was injected between pectoralis major and pectoralis minor muscle(PECS I)and 20 mL between pectoralis minor muscle and anterior serratus(PECS II).Then intravenous general anesthesia was induced with tracheal intubation and anesthesia was maintained with inhalational and intravenous anesthesia.After the surgery,patient was sent to the postoperative care unit(PACU)after extubation,and numerical rating scale(NRS)was recorded at PACU 0,4,12,24,48 h and 72 h after the surgery;time of first use of analgesic after the surgery,cumulative consumption of opioids within 72 hours after the surgery,incidence of postoperative nausea,vomiting,and length of hospital stay were recorded.Results There was no difference of NRS scores between LB group and group B at PACU 0,4,12,48 h and 72 h after the operation(P>0.05),but the score was lower in LB group than that in group B 24h after the surgery(P<0.05),and the scores of LB group and group C were significantly lower than those of group C(P<0.05).The time of first use of analgesic drugs in group B was shorter than that in LB group(P<0.05)and the time in group C was significantly shorter than that in group B and LB group(P<0.05).The cumulative amount of opioids in LB group was less than that in group B within 72 hours after the surgery,showing statistical significance(P<0.05),and the amount in group C was significantly more than that in LB group and group B(P<0.05).The incidence of postoperative nausea and vomiting was higher in group B than that in LB group(P<0.05),but it was the highest in group C(P<0.05).There was no difference in length of stay(LOS)of the three groups(P>0.05).Conclusion Ultrasound guided PECS block with liposome bupivacaine can provide better analgesia within 72 hours after total mammectomy,showing similar analgesic effect to that of bupipivacaine hydrochloride,but liposome bupivacaine may reduce amount of postoperative opioids consumption and decrease the incidence of nausea and vomiting.
作者
张力
李继勇
陈治军
ZHANG Li;LI Jiyong;CHEN Zhijun(Department of Anesthesiology,Wuhan No.1 Hospital,Wu han 430022,China)
出处
《实用医学杂志》
CAS
北大核心
2019年第20期3214-3217,共4页
The Journal of Practical Medicine
基金
国家自然科学基金资助项目(编号：81460177)
