超声引导下单次竖脊肌平面阻滞对单侧乳腺癌根治术后患者恢复的影响

目的探讨超声引导下单次竖脊肌平面(ESP)阻滞对单侧乳腺癌根治术后患者恢复的影响。方法依据随机数字表法将60例行单侧乳腺癌根治术的女性乳腺癌患者分为观察组和对照组,每组30例。麻醉诱导前两组患者均采用超声引导下患侧ESP阻滞,观察组患者给予0.5%盐酸罗哌卡因20 ml,对照组患者给予等量的生理盐水。两组患者均采用全凭静脉麻醉进行诱导和维持,术中采用喉罩通气,术后采用静脉自控镇痛。比较两组患者术后苏醒即刻及术后2、6、12、24、48 h的视觉模拟评分法(VAS)评分,比较两组患者术后镇痛泵按压次数、镇痛药吗啡的用量及术后并发症发生情况。结果术后苏醒即刻及术后2、6、12、24、48 h,观察组患者的VAS评分均明显低于对照组(P﹤0.01)。观察组患者术后镇痛泵按压次数和吗啡用量均明显低于对照组(P﹤0.01)。观察组患者术后恶心呕吐和皮肤瘙痒的发生率均低于对照组(P﹤0.05)。结论超声引导下单次ESP阻滞可以缓解单侧乳腺癌根治术后患者的急性疼痛,降低术后相关并发症发生率,促进患者术后恢复。

Effects of ultrasound-guided single-injection erector spinae plane block on postoperative recovery of patients after unilateral radical mastectomy

Objective To evaluate the effect of ultrasound-guided single-injection erector spinae plane(ESP)block on the postoperative recovery of patients after unilateral radical mastectomy.Method Sixty female patients undergoing unilateral radical mastectomy were included and randomized into two groups as study group and control group(30 cases in each group),respectively.Ultrasound-guided ESP block was performed in both groups before anesthesia induction,20 ml of 0.5%ropivacaine hydrochloride and equivalent normal saline were injected in study group and control group,respectively.All patients were administered with total intravenous anesthesia(TIVA)for anesthesia induction and maintenance,laryngeal mask airway was utilized for intraoperative ventilation,and patient-controlled intravenous analgesia(PCIA)was adopted for postoperative pain management.Visual analogue scale(VAS)was used to evaluate the pain at the time of waking up immediately after surgery,and at 2,6,12,24 and 48 hours thereafter.Pressing frequency of PCIA pump and dosages of morphine were recorded.Postoperative complications were evaluated.Result At the time of waking up immediately after surgery and at 2,6,12,24,and 24 h after surgery,the VAS scores recorded for study group were significantly lower compared to control group(P<0.01).Lower pressing frequency of PCIA pump and less morphine consumption were noted in study group than in control group(P<0.01).Significantly reduced incidence of nausea,vomiting and pruritus were observed for study group versus control group(P<0.05).Conclusion Ultrasound-guided single-injection ESP block alleviates the postoperative acute pain in patients with breast cancer undergoing unilateral radical mastectomy,with reduced incidence of related complications,and thus may help promote postoperative rehabilitation.