摘要
目的观察甲状腺手术时应用双侧颈神经通路阻滞能否满足手术麻醉的需求及术后镇痛效果,并观察记录其不良反应发生情况。方法选择2017年7月至2018年6月于北京积水潭医院普通外科就诊、18~65岁、美国麻醉医师协会分级Ⅰ~Ⅱ级、择期行甲状腺手术的患者25例,均行超声引导下双侧颈神经通路阻滞,每侧注射0.4%罗哌卡因15 mL,术中给予右美托咪定持续静脉泵注镇静。患者术后每间隔12小时静脉给予氟比洛芬酯100 mg镇痛,若患者术后出现数字评分法(NRS)评分≥4分,则肌内注射盐酸哌替啶50 mg镇痛。记录麻醉成功及失败比例,记录颈神经通路阻滞相关并发症(呼吸困难、声音嘶哑、出血及血肿)的发生情况,记录术后2、4、8、12、24、36及48 h时静息及运动(吞咽动作)NRS评分,观察镇痛相关不良反应的发生情况,记录患者对手术麻醉及术后镇痛的满意程度。结果除1例患者一侧枕小神经阻滞不全外,患者均获得了颈浅丛的完全阻滞,阻滞完全时间为(15.2±3.4)min。25例患者中有1例患者术中追加了局部浸润,1例在手术开始后4 h后改为全身麻醉,其余患者均于通路阻滞下完成手术。25例患者中7例(28.0%)出现心率加快、血压升高,其中6例(24.0%)合并出现声音嘶哑,声音嘶哑与心率加快、血压升高持续时间比较差异无统计学意义[(1.9±0.4)h比(2.0±0.3)h](P>0.05)。所有患者术后48 h内静息NRS评分均<4分,术后12 h后NRS评分较之前时间点升高。患者对麻醉及术后镇痛方式满意评分为(8.9±0.8)分。结论双侧颈神经通路阻滞,每侧给予0.4%罗哌卡因15 mL可以为甲状腺切除术甚至甲状腺癌根治术提供足够的手术麻醉效果,并可为术后提供48 h的有效镇痛,但局麻药在通路内向内侧扩散引起的迷走神经阻滞而出现的声音嘶哑及心率增快是常见并发情况。
Objective To observe the intraoperative and postoperative analgesic efficacy of ultrasound-guided bilateral cervical nerve pathway(CNP)block in patients undergoing thyroidectomy,and record the occurrence of complications.Methods A total of 25 patients visiting Department of General Surgery of Beijing Jishuitan Hospital from Jul.2017 to Jun.2018,aged 18 to 65 years old,of American Society of Anesthesiologists gradeⅠ-Ⅱ,undergoing elective thyroid surgery,were included in the study.All patients underwent ultrasound-guided bilateral cervical nerve pathway block,with 0.4% ropivacaine 15 mL injected each side.Continuous intravenous infusion of dexmedetomidine was given intraoperatively,and 100 mg intravenous flurbiprofen analgesic was given to all patients postoperatively every 12 h.In the event of the patient′s postoperative numerical rating scale(NRS)≥4,50 mg intramuscular pethidine hydrochloride was given for analgesia.Success and failure rates of anesthesia were recorded,along with cervical nerve pathway blockade-related complications such as respiratory difficulty,hoarse voice,hemorrhage and hematoma.Also noted were resting and movement(swallowing)NRS score at 2,4,8,12,24,36 and 48 h postoperatively,analgesia-related adverse effects and reactions,as well as satisfaction for surgical anesthesia and postoperative analgesia.Results Except one patient experiencing an incomplete lesser occipital nerve block at one side,all patients received a completely superficial cervical plexus block,complete time being(15.2±3.4)min.Among the 25 patients,one had an additional local infiltration,another received general anesthesia 4 h after the start of surgery,and all other patients completed surgery under CNP block.Seven cases(28.0%)experienced increased heart rate and blood pressure,among which hoarseness appeared in six cases(24.0%),and there was no statistically significant difference in the duration of hoarse voice and increased heart rate and blood pressure[(1.9±0.4)h vs(2.0±0.3)h](P>0.05).The resting NRS scores of all patients were<4 at 48 h postoperatively,and the 12 h NRS scores after surgery rose compared with the previous time points.Patient satisfaction with anesthesia and postoperative analgesia score was(8.9±0.8)score.Conclusion Bilateral CNP block with each side given 0.4%ropivacaine 15 mL can provide adequate anesthesia for thyroidectomy,and even radical mastectomy surgery for thyroid cancer,which can also offer at least 48 h effective analgesia postoperatively,however,hoarseness and heart rate increase caused by vagus nerve block caused by local anesthetics spreading inside the pathway are common complications.
作者
周雁
冯磊
种皓
林惠华
王庚
ZHOU Yan;FENG Lei;CHONG Hao;LIN Huihua;WANG Geng(Department of Anesthesiology,Beijing Jishuitan Hospital,Beijing 100035,China)
出处
《医学综述》
2019年第23期4607-4612,4620,共7页
Medical Recapitulate
基金
北京市属医院科研培育计划项目(PX2018017)
关键词
局部麻醉
镇痛
超声
颈神经丛
甲状腺
Local anesthesia
Analgesia
Ultrasound
Cervical plexus
Thyroid
