胸椎旁神经阻滞复合全身麻醉在腹腔镜大肠癌手术中的应用效果观察

目的:观察胸椎旁神经阻滞复合全身麻醉在腹腔镜大肠癌手术患者中的效果。方法:将腹腔镜大肠癌手术患者120例随机分为观察组和对照组,每组60例。观察组患者采用胸椎旁神经阻滞复合全身麻醉,对照组患者采用全身麻醉,观察2组患者镇痛持续时间、术后苏醒时间、住院时间,不同时段患者生命体征变化情况以及术后并发症发生率。结果:观察组患者镇痛持续时间长于对照组(P<0.05),术后苏醒时间、住院时间短于对照组(P<0.05)。手术前(T₀)2组患者心率(HR)、收缩压(SBP)、平均动脉压(MAP)、呼气末二氧化碳分压(P_ETCO₂)比较差异无统计学意义(P>0.05),麻醉给药15 min后(T₁)、手术开始30 min(T₂)、手术开始1 h(T₃)、手术结束时(T₄),观察组患者各指标均优于对照组(P<0.05)。观察组患者术后并发症发生率低于对照组(P<0.05)。结论:胸椎旁神经阻滞复合全身麻醉在腹腔镜大肠癌手术...     

胸椎旁阻滞复合全身麻醉对开胸单肺通气手术镇痛效果分析

目的:探讨胸椎旁阻滞与硬膜外阻滞复合全身麻醉对开胸单肺通气手术麻醉及镇痛效果分析。方法:选择我院2016年1月—2018年8月收治的75例行开胸单肺通气手术的肺癌患者,根据随机数字表法,患者分为A组(38例)及B组(37例),A组给予硬膜外阻滞复合全身麻醉,比较两组的麻醉效果、穿刺并发症、术后一周的胸部并发症、术后一周的肺部并发症。结果:A组术后一周肺部并发症发生率、麻醉起效时间、平均麻醉阻滞节段数明显高于B组,P0.05。两组的丙泊酚及芬太尼用量对比无统计学意义,P0.05;两组术后6、12、24、48 h静息状态下及术后6 h咳嗽状态下VAS评分对比无统计学意义,P0.05;B组术后12、24、48 h咳嗽状态下VAS评分明显低于A组,P0.05。T0-T5点,两组PaO_2及PvO_2对比无统计学意义,P0.05;T6点时,A组的PaO_2及PvO_2明显高于B组,T7点时,A组的PaO_2明显高于B组,P0.05。结论:胸椎旁阻滞复合全身麻醉与硬膜外阻滞复合全身麻醉的麻醉效果相同,术后运动性镇痛效果及术后氧合优于硬膜外阻滞,且术后胸部并发症较少。     

胸椎旁神经阻滞对开胸手术患者静脉镇痛效果的影响

目的 研究胸椎旁神经阻滞对开胸于术后静脉镇痛效果的影响.方法 择期全麻下肺叶切除术的患者102例,随机分成二三组:Ⅰ组,32例,单纯全麻;Ⅱ组,36例,于全麻诱导后行胸椎旁神经阻滞;Ⅲ组,34例.于全麻诱导前行硬膜外阻滞.三组均于术毕缝皮时启动患者静脉自控镇痛(PCIA)泵行芬太尼、氟比洛芬酯静脉镇痛,分别于患者清醒拔除气管导管后即刻(T1)、术后24 h(T2)、48 h(T3)进行视觉模拟评分(VAS),记录启动自控按钮次数及背景输注总量.结果 三组24、48 h PCIA泵的背景输注总晕差异无统计学意义.Ⅱ、Ⅲ组在T1、T2时的VAS均低于Ⅰ组(P＜0.05),术后48 h内启动自控按钮次数明显少于Ⅰ组(P＜0.05).结论 在开胸手术前行胸椎旁神经阻滞或硬膜外阻滞可以增强芬太尼、氟比洛芬酯的静脉镇痛效果.     

前锯肌平面阻滞与胸椎旁阻滞用于胸外科手术患者术后镇痛效果的Meta分析

目的 比较超声引导下前锯肌平面阻滞(SAPB)与胸椎旁阻滞(TPVB)对胸外科手术患者术后镇痛的效果。方法 检索Cochrane、Pubmed、Embase、Web of Science、中国知网、维普、万方和中国生物医学全文数据库,纳入SAPB与TPVB在成人胸外科手术后镇痛比较的随机对照试验(RCT)。按照Cochrane指导手册选择文献、提取资料及评价研究质量。采用RevMan 5.4进行Meta分析。结果 共纳入8篇RCTs,共计434例患者,其中SAPB组217例,TPVB组217例。两组术后1、2、4、6、12、24、48 h的静息及活动时VAS疼痛评分差异无统计学意义。SAPB组术后48 h内阿片类药物用量明显低于TPVB组(MD=-9.34μg, 95%CI-17.1～-1.58μg,P=0.02),低血压发生率明显低于TPVB组(RR=0.23, 95%CI 0.07～0.76,P=0.02)。结论 超声引导下SAPB与TPVB对胸外科手术患者术后镇痛效果相当,但采用SAPB患者术后阿片类药物用量明显减少、低血压发生率明显降低。     

胸椎旁神经阻滞和竖脊肌平面阻滞用于胸腔镜肺叶切除术术后镇痛效果的Meta分析

目的:通过Meta分析方法评价超声引导下胸椎旁神经阻滞（thoracic paravertebral nerve block, TPVB）和竖脊肌平面阻滞（erector spinae plane block, ESPB）用于胸腔镜肺叶切除术术后镇痛的效果。方法:计算机检索PubMed、Web of Science、C...     

前锯肌平面阻滞与胸椎旁神经阻滞用于胸腔镜手术患者术后镇痛效果的比较

目的比较前锯肌平面阻滞与胸椎旁神经阻滞用于胸腔镜手术患者术后的镇痛效果。方法选择择期行胸腔镜手术患者60例,男38例,女22例,年龄18～65岁,BMI 18～25kg/m2,ASAⅠ或Ⅱ级,采用随机数字表法分为前锯肌平面阻滞组(S组)和胸椎旁阻滞组(T组),每组30例。两组患者均采用支气管插管静脉全身麻醉,术后采用PCIA。S组于麻醉诱导前行超声引导下前锯肌平面阻滞,T组则行超声引导下胸椎旁阻滞,两组均使用0.4%罗哌卡因30ml,阻滞完成后30min使用针刺法测定并记录感觉阻滞平面;记录阻滞操作时间、起效时间、持续时间;记录术后2、4、8、12、24、48h的静息和咳嗽VAS评分;记录首次按压镇痛泵时间、术后48h内镇痛泵有效按压次数、舒芬太尼使用总量和哌替啶补救性镇痛例数;记录阻滞相关并发症、镇痛不良反应发生情况。结果与T组比较,S组阻滞操作时间明显缩短,阻滞持续时间明显延长(P0.01);S组术后12h静息时和咳嗽时VAS评分明显降低(P0.01),S组PCIA首次按压时间明显延长,S组PCIA 48h内按压次数、舒芬太尼使用量明显减少(P0.01),两组气胸、恶心呕吐发生率差异无统计学意义。结论超声引导下前锯肌平面阻滞或胸椎旁阻滞均可为胸腔镜手术患者提供良好术后镇痛,但前锯肌平面阻滞较胸椎旁阻滞作用更持久、操作时间更短、并发症更少,且能有效减少患者术后对阿片类药物的需求量。     

胸椎旁间隙阻滞的临床应用

胸椎旁间隙阻滞可产生完善的镇痛效果,降低术后VAS评分,减少阿片类镇痛药用量,对心肺功能影响小,术后肺部并发症少,应激反应减轻,恶心、呕吐发生率降低。此方法主要适用于开胸术后镇痛、乳腺手术等。     

胸椎旁间隙阻滞的临床应用

胸椎旁间隙阻滞可产生完善的镇痛效果，降低术后VAS评分，减少阿在镇痛药用量，对心肺功能影响小，术后肺部并发症少，应激反应减轻，恶心、呕吐发生率降低。此方法主要适用于开胸术后镇痛、乳腺手术等。     

General anaesthesia versus thoracic paravertebral block for breast surgery: A meta-analysis

Background

Thoracic paravertebral block (TPVB) offers an attractive alternative to general anaesthesia (GA) for ambulatory breast surgery. The aim of this meta-analysis was first to evaluate the safety and efficacy of TPVB for breast surgery, and second to compare TPVB with GA with regard to postoperative pain, nausea and vomiting, opioid consumption and length of hospital stay.

Methods

An electronic and manual search of English- and French-language articles on TPVB in breast surgery (published from January 1980 to June 2010) yielded 41 citations. Two levels of screening identified 11 relevant studies. The Mantel–Haenszel method (fixed effect) was used to perform the meta-analysis.

Results

Eleven studies were retained for analysis. When TPVB was used instead of GA, pain scores were significantly decreased at 1 and 6 h postoperatively (mean difference of 2.48 (95%confidence interval (CI): 2.20–2.75) and 1.71 (95%CI: 1.64–1.78), respectively). Furthermore, postoperative analgesic consumption was significantly lower in patients who received TPVB compared with GA (relative risk (RR) 0.23, (95%CI: 0.15–0.37)). TPVB was also associated with significantly less postoperative nausea and vomiting (RR 0.27 (95%CI: 0.12–0.61)). Increased patient satisfaction and a shorter hospital stay also favoured TPVB over GA.

Conclusions

TPVB provides effective anaesthesia for ambulatory breast surgery and can result in significant benefits over GA. However, further studies are required to determine whether these advantages would still be present if an optimal technique for outpatient GA is employed. Adjunctive ultrasonography may contribute to improve the safety of TPVB in breast surgery and requires further investigation.     

Thoracic paravertebral block versus pectoral nerve block for analgesia after breast surgery

BackgroundPectoral nerve block (Pecs) is a novel interfascial plane block which can provide analgesia after breast surgery while paravertebral block (PVB) is widely used for this purpose. We evaluated the difference between the two techniques in regard to morphine consumption and analgesic efficacy after modified radical mastectomy (MRM).MethodsSixty patients undergoing elective MRM were randomly allocated into either PVB with 15–20 ml of levobupivacaine 0.25% at the level of fourth thoracic vertebra or Pecs block with 10 ml of levobupivacaine 0.25% injected inbetween pectoralis major and pectoralis minor muscle and another 20 ml levobubivacaine 0.25% inbetween pectorlis minor and serratus anterior muscle. Primary outcome measure was morphine consumption in the first 24 h while secondary outcome measures included pain scores, intraoperative fentanyl consumption as well as postoperative nausea and vomiting (PONV).ResultsPostoperative morphine consumed at 24 h was significantly lower in Pecs group [21 (20–25) mg] than in PVB group [28 (22–31) mg], (p = 0.002). Time for first request of morphine was longer in Pecs group [175 (155–220) min] than in PVB group [137.5 (115–165) min], (p < 0.001). Numerical rating score (NRS) at rest was lower in Pecs group compared with PVB group at 1 h, 6 h and 12 h (p < 0.001) but at 18 h and 24 h it was lower in PVB group compared with Pecs group (p = 0.008 and <0.001 respectively). During movement, NRS was significantly lower at 1st hour in Pecs group (p < 0.001) while at 18 h and 24 h it was significantly lower in PVB group (p < 0.001). PONV was comparable between both groups.ConclusionPecs block reduced postoperative morphine consumption in the first 24 and pain scores in the first 12 h in comparison with PVB after mastectomy.     

Post-thoracotomy pain relief: Thoracic paravertebral block compared with systemic opioids

BackgroundWe evaluated the safety and efficacy of thoracic paravertebral block as a method of pain relief after thoracotomy in comparison with systemic opioids.Study designRandomized controlled trial.MethodsWe scheduled 40 patients divided into two groups to receive either 20 ml bupivacaine (0.5%) incremental injections for intra and postoperative analgesia via a catheter inserted in the thoracic paravertebral space. The other 20 patients received systemic morphine for postoperative analgesia. We recorded postoperative Visual Analog Scale pain score, total morphine consumption, time to first analgesic request, changes in pulmonary functions and side effects.ResultsVisual analogue scale (VAS) at rest was lower in the paravertebral group at all measurement points except at 16, 20 and 24 h postoperatively. Pain on coughing showed significant difference (P value < 0.05) at 8 and 16 h but not at 24 h. Post-operative consumption of morphine was 36 (22–42) mg in the control group versus 9 (2–22) mg in the paravertebral block group (PVB) (P value = 0.003). Total bupivacaine dose used in the PVB group in the first 24 h was 300–420 mg. For time to first analgesic request it was significantly longer in the morphine group than the paravertebral block group. VAS at first analgesic request was not statistically different between the two groups.There was no significant difference between the two groups as regards to peak expiratory flow rate (PEFR) preoperatively, after 12 h or 24 h.There was a significant reduction in the incidence of side effects in the TPVB group compared to morphine group concerning vomiting and pruritus.no local anesthetic toxicity was reported.ConclusionWe conclude that thoracic PVB provides effective post thoracotomy analgesia supported by lower VAS pain scores at rest and on coughing compared to intravenous morphine with significant less incidence of side effects.     

乳腺癌患者术前超声引导下胸椎旁神经阻滞与术后慢性疼痛的相关性

目的 采用倾向性评分匹配法(PSM)评估术前超声引导下胸椎旁神经阻滞(TPVB)与术后1年以上乳腺癌患者术后慢性疼痛(CPSP)的相关性.方法 回顾性收集2018年1月至2019年3月全麻下择期乳腺癌手术女性患者的临床资料,ASAⅠ—Ⅲ级.根据是否接受术前超声引导下TPVB将患者分为两组:TPVB联合全麻组(TG组)和...     

The efficacy of paravertebral block using a catheter technique for postoperative analgesia in thoracoscopic surgery: a randomized trial

Objective: The analgesic scheme combining paravertebral block (PVB) and intravenous non-steroidal anti-inflammatory drug (NSAID) has proven to be effective for postoperative pain control after thoracotomy. The hypothesis tested in this study was that this policy was also suitable to improve pain control after video-assisted thoracic surgery (VATS). Methods: This was a prospective randomized study on 40 patients submitted to three-ports’ VATS for pneumothorax or solitary pulmonary nodule. The sample size was calculated to detect one point of minimum pain score difference with 80% statistical power. Patients were randomly assigned to two groups: (1) paravertebral block group (PVB) (n = 20) – At the end of surgery, a catheter was placed in patients in the thoracic paravertebral space under camera control; they received a bolus of 15 ml of local anesthetic (ropivacaine 0.2%) every 6 h, combined with endovenous metamizol (1 g); and (2) alternate NSAIDs group (AN) (n = 20) – They were treated with paracetamol (1 g) combined with metamizol (1 g) every 6 h. Subcutaneous meperidine (synthetic opioid) was employed as rescue drug. Both groups were comparable in terms of age, sex, pathology, and co-morbidity. Pain level was measured with the visual analog scale (VAS) at 1, 6, 24, and 48 h. Results: No side effects related to any of the two analgesic techniques were noted. Two patients needed rescue meperidine in the AN group, and none in the PVB group. VAS scores were the following: PVB group, VAS 1 h: 1.4 ± 0.8, VAS 6 h: 3.4 ± 1.2, VAS 24 h: 2.6 ± 1.0, VAS 48 h: 2.2 ± 0.9, and mean VAS: 2.4 ± 1.3; AN group, VAS 1 h: 2.8 ± 1.0, VAS 6 h: 4.9 ± 1.3, VAS 24 h: 3.9 ± 1.4, VAS 48 h: 3.3 ± 1.0, and mean VAS: 3.8 ± 1.4. VAS scores were significantly lower at any time in the PVB patients (p < 0.01). Conclusions: The analgesic regimen combining PVB and NSAID provided an excellent level of pain control. Thoracoscopy assisted positioning of the paravertebral catheter is simple and effective, and allows direct visualization of correct delivery of local anesthetic. It represents a valuable addition to any VATS procedure.     

超声引导下胸椎旁神经阻滞和菱形肌-肋间肌阻滞对胸腔镜术后恢复质量的影响

目的 观察超声引导下胸椎旁神经阻滞(TPVB)和菱形肌-肋间肌阻滞(RIB)对胸腔镜手术患者术后早期疼痛及术后康复质量的影响。
方法 选择全麻下行胸腔镜肺癌根治术患者78例,男51例,女27例,年龄50～70岁,ASAⅠ或Ⅱ级。随机分为两组:超声引导下TPVB组(A组)和超声引导下RIB组(B组),每组39例。全麻诱导前,A组、B组分别采用0.33%罗哌卡因25 ml行超声引导下TPVB和RIB。记录阻滞操作时间和阻滞持续时间。记录术后2、6、24静息和活动时VAS疼痛评分。记录术后24 h内舒芬太尼用量和补救镇痛例数。记录开始进食时间、开始下地时间和术后住院时间。记录PACU低氧血症、气胸、穿刺部位出血或血肿、局麻药中毒、术后谵妄、术后肺不张、恶心呕吐等并发症的发生情况。
结果 B组阻滞操作时间明显短于A组(P<0.05)。两组阻滞持续时间、不同时点静息和活动时VAS疼痛评分、术后24 h内舒芬太尼用量、补救镇痛率、开始进食时间、开始下地时间、术后住院时间差异无统计学意义。两组并发症发生率差异无统计学意义。
结论 在胸腔镜肺癌根治术中,行超声引导下菱形肌-肋间肌阻滞的患者术后恢复质量不差于行胸椎旁神经阻滞的患者。     

Single injection paravertebral block for renal surgery in children

Background:  Continuous paravertebral block (PVB) has been successfully used for postoperative analgesia in children. However, data regarding the efficacy of a single injection technique for major renal surgery are still lacking.
Methods:  Following the ethics committee approval and parent informed consent, 24 children (median 10.3 months; range: 2.9–26.8) undergoing major renal surgery were included in a prospective observational pilot study. Following a standardized general anesthetic the patients were administered a single injection low thoracic PVB (loss-of-resistance technique; 0.5 ml·kg⁻¹ of levobupivacaine 2.5 mg·ml⁻¹ with epinephrine 5 μg·ml⁻¹) at the end of surgery. Postoperative pain was assessed by Face, Legs, Activity, Cry, Consolability (FLACC) score at predetermined time points and in case of apparent patients' discomfort during the first 12 postoperative hours. The duration of postoperative analgesia was defined as the interval between PVB and the first supplemental administration of a rescue opioid analgesic. The incidence of complications and postoperative vomiting (POV) was also recorded.
Results:  A successful PVB was achieved in 23/24 patients (95.8%). The median duration of the block was 600 min (range: 180–720 min) with 10 children not requiring any supplemental analgesia during the 12-h observation period. Vascular puncture was observed in 2/24 children (8.3%) and POV occurred in 4/24 children (16.7%). All complications were considered minor and did not influence recovery.
Conclusions:  Single injection PVB provided clinically relevant postoperative analgesia in children undergoing major renal surgery.     

Prospective randomized trial of paravertebral block for patients undergoing breast cancer surgery

Background

The goal of the current study was to evaluate the effect of regional anesthesia using paravertebral block (PVB) on postoperative pain after breast surgery.

Methods

Patients undergoing unilateral breast surgery without reconstruction were randomized to general anesthesia (GA) only or PVB with GA and pain scores assessed.

Results

Eighty patients were randomized (41 to GA and 39 to PVB with GA). Operative times were not significantly different between groups. Pain scores were lower after PVB compared to GA at 1 hour (1 vs 3, P = .006) and 3 hours (0 vs 2, P = .001) but not at later time points. The overall worst pain experienced was lower with PVB (3 vs 5, P = .02). More patients were pain-free in the PVB group at 1 hour (44% vs 17%, P = .014) and 3 hours (54% vs 17%, P = .005) postoperatively.

Conclusions

PVB significantly decreases postoperative pain up to 3 hours after breast cancer surgery.