超声引导两点法胸椎旁神经阻滞用于腹腔镜胆囊切除术老年患者术后镇痛
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摘要
目的观察超声引导两点法胸椎旁神经阻滞用于腹腔镜胆囊切除术老年患者术后镇痛的有效性和安全性。方法选择行腹腔镜胆囊切除手术老年患者80例,随机分为两组,每组40例,分别采用单点法胸椎旁神经阻滞组(A组)和两点法胸椎旁神经阻滞组(B组)。全麻诱导前均行超声引导下胸椎旁神经阻滞。A组患者穿刺点选择为右侧胸8～胸9胸椎旁间隙,局部麻醉药物选择0.5%的罗哌卡因20 ml;B组患者穿刺点选择为右侧胸5～胸6胸椎旁间隙和右侧胸10～胸11胸椎旁间隙,每个点注射局部麻醉药物0.5%的罗哌卡因10 ml,总共为20 ml。观察两组患者在术后4 h、8 h、12 h、24 h时静息痛、活动痛的视觉模拟评分法(VAS)评分;同时记录患者手术后肛门恢复排气时间以及围术期低血压等发生情况。结果 B组患者术后4 h、8 h、12 h、24 h血压明显高于A组,差异均有统计学意义(t分别=-2.28、-2.60、-2.31、-2.20,P均<0.05);B组静息痛和活动痛VAS评分均明显低于A组,差异均有统计学意义(U分别=800.00、584.00、594.00、573.50、612.50、595.00、573.50、589.50,P均<0.05);B组患者术后肛门恢复排气时间明显短于A组,差异有统计学意义(t=2.24,P<0.05)。两组术后24 h内头晕、恶心、呕吐、皮肤瘙痒发生率比较,差异均无统计学意义(χ~2分别=0.07、0.39、0.13、0.16,P均>0.05)。两组患者术后均未发生局麻药中毒和呼吸抑制。结论超声引导下两点法胸椎旁神经阻滞用于腹腔镜胆囊切除术老年患者术后镇痛是有效和安全的。两点法比单点法有更好的镇痛效果,且肛门恢复排气时间更短。
Objective To observe the efficacy and safety of dual-injection technique in ultrasound-guided thoracic paravertebral blockade for postoperative analgesia of laparoscopic cholecystectomy in elderly patients.Methods A total of 80 elderly patients scheduled for laparoscopic cholecystectomy were enrolled and randomly divided into two groups with 40 cases in each:single-injection technique of ultrasound-guided thoracic paravertebral blockade group(group A)and dual-injection technique of ultrasound-guided thoracic paravertebral blockade group(group B).Before induction of general anesthesia,paravertebral nerve block under ultrasound guidance was performed.In group A,the puncture point was right paravertebral space T8～T9,and 0.5% ropivacaine 20 ml was injected.In group B,the puncture site was the right paraspinal space T5～T6 and the right paraspinal space T10～T11,and 0.5% ropivacaine 10 ml was injected at each site.The VAS score of rest pain and activity pain were observed at 4 h,8 h,12 h and 24 h after operation.The recovery time of anal exhaust and the incidence of hypotension in perioperation were also recorded.Results The blood pressure in group B was significantly higher than that in group A at 4 h,8 h,12 h and 24 h after operation,the difference was statistically significant(t=-2.28,-2.60,-2.31,-2.20,P<0.05).The VAS scores of resting and active in group B were significantly lower than those in the group A,and the difference was statistically significant(U=800.00,584.00,594.00,573.50,612.50,595.00,573.50,589.50,P<0.05).The postoperative anal recovery exhaust time of the patients in group B was significantly shorter than that in group A(t=2.24,P<0.05).There was no significant difference in the incidence of dizziness,nausea,vomiting,and pruritus within 24 h after surgery(χ~2=0.07,0.39,0.13,0.16,P>0.05).No local anesthetic poisoning and respiratory depression occurred in the two groups after surgery.Conclusion Dual-injection technique in ultrasound-guided thoracic paravertebral blockade is effective and safe for postoperative analgesia effect of laparoscopic cholecystectomy in elderly patients.The dual-injection technique of ultrasound-guided thoracic paravertebral blockade is more effective than the single-injection technique on the postoperative analgesia effect for laparoscopic cholecystectomy in elderly patients with shorter postoperative anal recovery exhaust time.
Objective To observe the efficacy and safety of dual-injection technique in ultrasound-guided thoracic paravertebral blockade for postoperative analgesia of laparoscopic cholecystectomy in elderly patients.Methods A total of 80 elderly patients scheduled for laparoscopic cholecystectomy were enrolled and randomly divided into two groups with 40 cases in each:single-injection technique of ultrasound-guided thoracic paravertebral blockade group(group A)and dual-injection technique of ultrasound-guided thoracic paravertebral blockade group(group B).Before induction of general anesthesia,paravertebral nerve block under ultrasound guidance was performed.In group A,the puncture point was right paravertebral space T8～T9,and 0.5% ropivacaine 20 ml was injected.In group B,the puncture site was the right paraspinal space T5～T6 and the right paraspinal space T10～T11,and 0.5% ropivacaine 10 ml was injected at each site.The VAS score of rest pain and activity pain were observed at 4 h,8 h,12 h and 24 h after operation.The recovery time of anal exhaust and the incidence of hypotension in perioperation were also recorded.Results The blood pressure in group B was significantly higher than that in group A at 4 h,8 h,12 h and 24 h after operation,the difference was statistically significant(t=-2.28,-2.60,-2.31,-2.20,P<0.05).The VAS scores of resting and active in group B were significantly lower than those in the group A,and the difference was statistically significant(U=800.00,584.00,594.00,573.50,612.50,595.00,573.50,589.50,P<0.05).The postoperative anal recovery exhaust time of the patients in group B was significantly shorter than that in group A(t=2.24,P<0.05).There was no significant difference in the incidence of dizziness,nausea,vomiting,and pruritus within 24 h after surgery(χ~2=0.07,0.39,0.13,0.16,P>0.05).No local anesthetic poisoning and respiratory depression occurred in the two groups after surgery.Conclusion Dual-injection technique in ultrasound-guided thoracic paravertebral blockade is effective and safe for postoperative analgesia effect of laparoscopic cholecystectomy in elderly patients.The dual-injection technique of ultrasound-guided thoracic paravertebral blockade is more effective than the single-injection technique on the postoperative analgesia effect for laparoscopic cholecystectomy in elderly patients with shorter postoperative anal recovery exhaust time.
引文
1 Ruiz-Tovar J,Garcia A,Ferrigni C,et al.Laparoscopic-guided transversus abdominis plane(TAP)block as part of multimodal analgesia in laparoscopic roux-en-y gastric bypass within an enhanced recovery after surgery(ERAS)program:a prospective randomized clinical trial[J].Obes Surg,2018,28(11):3374-3379.
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3 Gan TJ.Poorly controlled postoperative pain:prevalence,consequences,and prevention[J].J Pain Res,2017,10(9):2287-2298.
4 Pace MM,Sharma B,Anderson-Dam J,et al.Ultrasound-guided thoracic paravertebral blockade:a retrospective study of the incidence of complications[J].Anesth Analg,2016,122(4):1186-1191.
5 Costache I,Sinclair J,Farrash FA,et al.Does paravertebral block require access to the paravertebral space?[J].Anaesthesia,2016,71(7):858-859.
6 Marhofer D,Marhofer P,Kettner SC,et a1.Magnetic resonance imaging analysis of the spread of local anesthetic solution after ultrasound-guided lateral thoracic paravertebral blockade:a volunteer study[J].Anesthesiology,2013,118(5):1106-1112.
7倪航航,周霞,梁志宏,等.膈下引流管对腹腔镜胆囊切除术后72 h内肩痛的影响[J].中国微创外科杂志,2016,16(7):628-631.
8刘松彬,王华婴,张基,等.腹腔镜胆囊切除术后镇痛现状[J].腹腔镜外科杂志,2017,22(9):713-716.
9徐步远,蔡秀军.左布比卡因局部浸润对腹腔镜胆囊切除术术后镇痛效果的临床观察[J].全科医学临床与教育,2011,9(2):131-133.
2 Pilleri A,Scorcu G.New assessment for advanced age:Italian study protocol on the assessment of surgical risk in the over-75-year age-group[J].Monaldi Arch Chest Dis,2017,87(2):850.
3 Gan TJ.Poorly controlled postoperative pain:prevalence,consequences,and prevention[J].J Pain Res,2017,10(9):2287-2298.
4 Pace MM,Sharma B,Anderson-Dam J,et al.Ultrasound-guided thoracic paravertebral blockade:a retrospective study of the incidence of complications[J].Anesth Analg,2016,122(4):1186-1191.
5 Costache I,Sinclair J,Farrash FA,et al.Does paravertebral block require access to the paravertebral space?[J].Anaesthesia,2016,71(7):858-859.
6 Marhofer D,Marhofer P,Kettner SC,et a1.Magnetic resonance imaging analysis of the spread of local anesthetic solution after ultrasound-guided lateral thoracic paravertebral blockade:a volunteer study[J].Anesthesiology,2013,118(5):1106-1112.
7倪航航,周霞,梁志宏,等.膈下引流管对腹腔镜胆囊切除术后72 h内肩痛的影响[J].中国微创外科杂志,2016,16(7):628-631.
8刘松彬,王华婴,张基,等.腹腔镜胆囊切除术后镇痛现状[J].腹腔镜外科杂志,2017,22(9):713-716.
9徐步远,蔡秀军.左布比卡因局部浸润对腹腔镜胆囊切除术术后镇痛效果的临床观察[J].全科医学临床与教育,2011,9(2):131-133.