超声引导颈神经通路阻滞和颈浅丛阻滞对甲状腺切除术镇痛效果的比较

目的比较超声引导下颈神经通路阻滞和颈浅丛阻滞对全麻下行甲状腺切除术患者的镇痛效果。方法本研究采用随机、对照、双盲的试验方法 ,选择年龄18~65岁、美国麻醉医师协会麻醉（ASA）分级Ⅰ~Ⅱ级、全麻下行择期甲状腺切除术的患者42例,随机分为颈浅丛阻滞组（S组,n=21）和颈神经通路阻滞组（P组,n=21）。全麻诱导后手术开始前,S组和P组分别行超声引导下双侧颈浅丛阻滞和超声引导下双侧颈神经通路阻滞,每侧均给予0.4%罗哌卡因20 mL,总计40 mL。术后使用舒芬太尼静脉自控镇痛至术后48 h。观察手术切皮时心率血压的变化,记录手术时间及术中阿片类药物的消耗量;记录术后拔管时间和恢复室停留时间;记录术后1、4、8、12、24、36、48 h静息及运动（吞咽）的视觉模拟评分（VAS）;记录术后阿片类药物消耗量及恶心、呕吐、过度镇静、呼吸困难、声嘶等不良反应的发生率。结果切皮前后收缩压（SBP）变化[M（Q）][3.0（3.0）mm Hg比4.0（5.3）mm Hg,Z=-0.547,P〉0.05]、舒张压（DBP）变化[4.0（3.0）mm Hg比2.0（6.5）mm Hg,Z=-1.050,P〉0.05]及心率（HR）变化[3.0（2.0）次/min比2.0（4.0）次/min,Z=-1.408,P〉0.05]、术中芬太尼用量[（155.9±43.4）μg比（169.0±40.0）μg,t=1.007,P〉0.05]、首次觅求舒芬太尼时间[（1157.8±99.2）min比（1275.5±119.4）min,t=0.523,P〉0.05）]两组差异无统计学意义。术后0~12 h两组均未使用舒芬太尼。术后12~24 h舒芬太尼使用量、24~36 h舒芬太尼使用量及36~48 h舒芬太尼使用量两组差异无统计学意义。术后1 h运动VAS评分[2.0（1.0）比4.0（2.0）,Z=-0.304,P=0.001]、4 h运动VAS评分[（3.0（2.0）比4.0（2.0）,Z=-3.082,P〈0.01]、8 h运动VAS评分[2.0（0.0）比2.0（2.0）,Z=-2.992,P〈0.01]、12 h运动VAS评分[3.0（1.0）比4.0（1.0）,Z=-5.410,P〈0.001]P组低于S组,术后4、8、12、24、36、48 h静息VAS及24、36、48 h运?

Comparison of analgesic efficacy of ultrasound-guided bilateral superficial cervical plexus block and cervical nerves pathway block in patients undergoing thyroidectomy

Objective To compare the analgesic efficacy of ultrasound-guided bilateral superficial cervical plexus block and cervical nerves pathway block in patients undergoing thyroidectomy. Methods A randomized, double-blind,controlled trial was performed. 42 patients with 18-65 age, ASA Ⅰ-Ⅱ undergoing thyroidectomy were enrolled into two groups： group S（n = 21） and group P（n = 21）. All patients received ultrasound-guided bilateral superficial cervical plexus block（group S） and cervical nerves pathway block（group P） with 0.4% Ropivacaine 40 mL respectively after induction and intubation. Sufentanil was used for postoperative 48 h rescue analgesia. BP and HR changes before and after incision and Fentanyl usage during surgery were recorded. The extubation time and PACU time, the time interval between surgery finish and first Sufentanil needed were recorded. Each patient was assessed 1, 4, 8, 12, 24 36, 48 h after surgery for resting and moving VAS score. Opioids usage, nausea, vomiting, drowsiness, dyspnea, trachyphonia were recorded. Results There was no difference in [M（Q）] SBP [3.0（3.0） mm Hg vs 4.0（5.3） mm Hg, Z =-0.547, P〉0.05], DBP [4.0（3.0） mm Hg vs 2.0（6.5） mm Hg, Z =-1.050, P〉0.05] and HR [3.0（2.0） times/min vs 2.0（4.0） times/min, Z =-1.408, P〉0.05] changes before and after incision, Fentanyl usage during surgery [（155.9±43.4） μg vs（169.0±40.0） μg, t = 1.007, P〉0.05） and time interval between surgery finish and first Sufentanil needed [（1157.8±99.2） min vs（1275.5±119.4） min, t = 0.523, P〈0.05]. The CNP block reduced VAS score on 1, 4, 6, 12 h postoperative time points on movement [2.0（1.0） vs 4.0（2.0）, Z =-0.304, P = 0.001; 3.0（2.0） vs 4.0（2.0）, Z =-3.082, P〈0.01; 2.0（0.0） vs 2.0（2.0）, Z =-2.99, P〉0.01; 3.0（1.0） vs 4.0（1.0）, Z =-5.410, P〉0.001]. There were no differences in the resting VAS at 4, 8, 12, 24, 36, 48 h after operation and moving VAS at 24, 36, 48 h after operation（P〉0.05）. The