腹直肌鞘阻滞复合静脉自控镇痛与连续硬膜外阻滞用于胃癌术后镇痛效果比较

目的 比较超声引导下腹直肌鞘阻滞复合静脉自控镇痛与连续硬膜外阻滞在胃癌根治术患者术后镇痛效果.方法 择期行胃癌根治术患者120例,性别不限,年龄18～70岁.ASA分级Ⅰ、Ⅱ、Ⅲ级.按照随机数字表法分为两组:超声引导下腹直肌鞘阻滞复合静脉自控镇痛组(R组)、连续硬膜外阻滞组(E组),每组60例.R组患者手术缝皮后行超声引导下腹直肌鞘阻滞,并连接静脉自控镇痛泵;E组患者于T8～T9或T9～T10间隙行硬膜外置管,术后接硬膜外镇痛泵.在术后2、6、12、24、36、48 h,以疼痛VAS作为首要指标,同时观察术后72 h补救镇痛的比例、副作用发生率、尿管拔除时间、胃肠功能恢复时间、早期活动时间以及住院时间. 结果 与E组比较,R组术后各时间点疼痛VAS、补救镇痛比例、胃肠功能恢复、恶心呕吐发生率和住院时间差异均无统计学意义(P＞0.05);R组尿管拔除时间[2.0(1～4)d]、早期活动时间[5(2～11)d]、术后72 h低血压发生率[8例(13.56％)]以及暂停镇痛泵例数[4例(6.78％)]均低于E组[3.5(3～4)d、9(6～12)d、25例(43.10％)、16例(27.58％)],差异有统计学意义(P＜0.05). 结论 超声引导下腹直肌鞘阻滞复合静脉自控镇痛与连续硬膜外阻滞镇痛在胃癌术后具有相似的镇痛效果和术后康复时间,但副作用发生率低.

The effect of rectus sheath block combined with intravenous analgesia which compared with versus epidural analgesia after cancer radical gastrectomy

Objective To compare the analgesic effect of ultrasound-guided rectus sheath block (group R) combined with patient controlled intravenous analgesia to continuous epidural analgesia (group E) after radical gastrectomy.Methods one hundred and twenty adult patients (n=60).ASA grade Ⅰ or Ⅱ or Ⅲ and scheduled for radical gastrectomy were divided into two groups randomly (group R and group E).In group R,patients received ultrasound-guided rectus sheath block combined with patientcontrolled intravenous analgesia after skin closure.In group E,an epidural catheter was prepositioned in the T8-T9 or Tg-T11 before surgery.Patients received patient-controlled epidural analgesia (PCEA) after surgery.The primary outcome measures were the visual analogue scale scores at 2,6,12,24,36,48 h after surgery.The percent of additional analgesic,the analgesic technique related side effects,the time to removal of the urinary catheter,the time to gastrointestinal function recovery,the time to walk and the length of hospital stay were recorded at 72 h postoperatively.Results There is no significant difference in visual analogue scale scores,supplemental analgesia,the recovery time of gastrointestinal function,the incidence of nausea and vomiting,and the duration of hospital stay (P＞0.05).Compared with group E [3.5 (3-4) d,9 (6-12) d,25 (43.10％),16 (27.58％)],group R had less time to the removal of the urinary catheter[2.0(1-4) d],less time to walk[5(2-11) d],less incidence of hypotension[8(13.56％)] and less times of suspending pump[4(6.78％)](P＜0.05).Conclusions Two groups have similar analgesia effect and early rehabilitation.However,the complications of analgesia are less in patients with rectus sheath block combined with patient-controlled intravenous analgesia.