目的 观察前锯肌浅、深层平面阻滞在乳腺癌手术患者围术期的镇痛效果.方法 选择 2020 年 8月—2022 年7 月择期全麻下初次行乳腺癌改良根治术60 例,随机分为前锯肌浅层平面阻滞组(S组)、前锯肌深层平面阻滞组(D组)和对照组(C组),每组20 例.S组与D组分别于麻醉前超声引导下识别前锯肌浅层和深层平面,并注入0.5%罗哌卡因注射液20 mL,注药后30 min利用针刺法测定痛觉减退的范围;C组直接行全身麻醉.记录3 组麻醉诱导前、切皮前、切皮后3 min的平均动脉压(MAP)和心率,术中瑞芬太尼用量、出血量和手术时间;记录 3 组术前、术后24 和48h恢复质量,拔管即刻及术后2h、6h、12h、24h和48h安静和咳嗽状态下视觉模拟评分法(VAS)评分,补救镇痛例数及不良反应、并发症发生情况.结果 S组有3 例剔除,共纳入17 例.S组和D组均可产生锁骨中线～腋后线、第3～6 肋节段痛觉阳性区域,但均未超过前正中线;在相同节段D组阳性例数多于S组.与C组相比,S组和D组在切皮后3 min MAP和心率低,术中瑞芬太尼用量、术后12h和24h补救镇痛例数减少,术后24 h 15 项恢复质量量表评分升高(P<0.05).安静时,S组和D组拔管即刻、术后 2h、6h、12h和 24 h VAS评分均低于C组(P<0.05);咳嗽时,S组拔管即刻、术后2h和 6hVAS评分均低于C组,D组拔管即刻、术后 2h、6h、12h和 24h VAS评分均低于C组(P<0.05);D组术后12h和24 h VAS评分低于S组(P<0.05).3 组不良反应发生率比较差异无统计学意义(P>0.05),均未发生严重并发症.结论 前锯肌浅层和深层平面阻滞均能为乳腺癌手术患者提供满意的围术期镇痛,且与浅层平面阻滞相比,深层平面阻滞在超声下操作更易建立,对手术操作影响小,术后镇痛效果确切.
Comparison of the Analgesic Effect of Superficial and Deep Serratus Anterior Plane Block in Patients Undergoing Radical Mastectomy for Breast Cancer
Objective To evaluate the analgesic effect of superficial and deep serratus anterior plane block in patients undergoing surgery for breast cancer during perioperative period.Methods Sixty patients who underwent modified radical mastectomy for the first time under elective general anesthesia from August 2020 to July 2022 were selected and randomly di-vided into superficial anterior serrated muscle plane block group(group S),deep anterior serrated muscle plane block group(group D)and control group(group C),with 20 patients in each group.In group S and group D,the superficial and deep plane of the anterior serration muscle were identified under the guidance of ultrasound,20 mL of 0.5%Ropivacaine injection was injected,and the range of hypoalgesia was measured by acupuncture at 30 min after injection.Group C received general anesthesia directly.The mean arterial pressure(MAP),heart rate,intraoperative Remifentanil dosage,blood loss and dura-tion of operation of the three groups were recorded before anesthesia induction(T0),before incision(T1)and at 3 min after incision(T2).The quality of recovery before surgery,and at 24 and 48 h after surgery,visual analogue scale(VAS)scores immediately after extubation and at 2,6,12,24 and 48 h after surgery at rest and during cough were recorded in the three groups,and the number of remedial analgesia cases,adverse reactions and complications were recorded.Results Three ca-ses were excluded from Group S,and a total of 17 cases were included.Pain positive areas from the midline of the clavicle to the posterior axillary line,and at T3～T6 segments could be produced in both groups S and D,but did not exceed the anterior medi-an line.The number of positive cases in group D was more than that in group S in the same segment.Compared with group C,the MAP and heart rate at T2 in groups S and D were lower than those in group C,the intraoperative Remifentanil dosage,the number of remedial analgesia at 12 and 24 h after surgery were reduced,and the QoR-15 score at 24 h after surgery was in-creased(P<0.05).At rest,VAS scores in groups S and D immediately after extubation,and at 2 h,6 h,12 h and 24 h after surgery were lower than those in group C(P<0.05).During cough,the VAS scores of group S immediately after extubation,and at 2 h and 6 h after surgery were lower than those of group C,and the VAS scores of group D immediately after extubation,and at 2 h,6 h,12 h and 24 h after surgery were lower than those of group C(P<0.05).The VAS scores at 12 h and 24 h af-ter operation in group D were lower than those in group S(P<0.05).There was no significant difference in the incidence of ad-verse reactions among the three groups(P>0.05),and no serious complications occurred.Conclusion Both superficial and deep superficial and deep serratus anterior plane block can provide satisfactory analgesic effect during perioperative period for pa-tients undergoing surgery for breast cancer.Compared with superficial block,deep plane block is more likely to be established under ultrasound,which has fewer impacts on surgical operation,and has more significant postoperative analgesia effect.
Breast neoplasmsMastectomy,radicalSerratus anterior plane blockAnesthesia and analgesiaHe-modynamicsPain MeasurementRecovery quality
万方数据
维普
