超声引导胸椎旁神经阻滞对于肋骨骨折患者术后镇痛效果的影响

目的观察超声引导胸椎旁神经阻滞(TPVB)对于肋骨骨折患者术后镇痛效果的影响。方法 40例择期行肋骨骨折切开复位内固定术的患者,随机分为全麻组(GA组,n=20)和全麻联合胸椎旁神经阻滞组(GA+TPVB组,n=20)。GA组接受标准的全身麻醉。在GA+TPVB组,全麻诱导后以0.5%罗哌卡因行患侧超声引导胸椎旁神经阻滞。所有患者在麻醉后恢复室(PACU)开始接受含有舒芬太尼的静脉镇痛泵,术后前3d应用注射用帕瑞昔布钠(特耐)40mg静脉推注,每日2次。记录两组患者术中切皮前后5min平均动脉压(MAP)及心率(HR)变化,术中舒芬太尼的用量;于术后1、12、24、48和72h对患者进行静息和活动下(深呼吸、咳嗽时)疼痛评估,主要预后指标为所有视觉模拟评分法(VAS);记录患者满意度;同时观察术后有无血肿、恶心、呕吐、呼吸抑制等不良反应的发生。结果与GA组比较,GA+TPVB组切皮前后MAP、HR波动明显减小(P0.05),术中舒芬太尼用量明显减少(P0.05);两组患者术后1、12、24、48h的VAS有显著差异,与GA组比较,GA+TPVB组VAS明显降低(P0.05);GA组和GA+TPVB组术后呕吐发生率分别为15%和0,差异有统计学意义(P0.05)。术后两组患者均未见血肿、呼吸抑制等不良反应发生。结论超声引导胸椎旁神经阻滞定位准确,操作成功率高,明显减少围手术期镇痛药物用量,提供有效的术后镇痛。

Effects of ultrasound-guided thoracic paravertebral nerve block on postoperative analgesia in patients with rib fracture

Objective To observe the effects of ultrasound-guided thoracic paravertebral nerve block on postoperative analgesia in patients with rib fracture .Methods Forty patients scheduled for rib fracture internal fix-ation under general anesthesia were randomly divided into two groups ( n =20 each ): general anesthesia group (group GA) and general anesthesia combined with thoracic paravertebral nerve block group (group GA+TPVB). After induction of anesthesia ,ultrasound-guided thoracic paravertebral nerve block was performed and 0.5%Ropiva-caine was injected in group GA +TPVB,while nothing was done in group GA .All patients received intravenous an-algesia with sufentanil in the PACU .Dynastat 40 mg was injected at two times a day in the first three days after sur-gery.The hemodynamic parameters during skin incision were recorded .The consumption of sufentanil during opera-tion and VAS score at 1,6,12,24 and 48h after operation were recorded .The adverse reactions were also recorded . Results Compared with group GA ,hemodynamic parameters in group GA +TPVB maintained even stable during skin incision(P<0.05);sufentanil consumption was significantly reduced during operation (P<0.05);VAS at 1, 6,12,24 and 48h after operation were significantly lower (P<0.05).The postoperative vomitting rate in group GA and group GA+TPVB was 15%and 0, respectively.There was no adverse reaction in either groups .Conclusion Ultrasound-guided thoracic paravertebral nerve block can provide accurate positioning ,high operation success rate , and effective analgesia .And it can obviously decrease the need for analgesic drugs in perioperative period .