前锯肌平面阻滞对非小细胞肺癌胸腔镜根治术患者术后镇痛效果的影响
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摘要
目的探讨前锯肌平面阻滞对胸腔镜手术患者术后镇痛效果的影响。方法选取2017年7—12月住院治疗的早期非小细胞肺癌患者40例,性别不限,年龄48～67岁,BMI 21.3～26.7 kg/m~2,ASAⅠ或Ⅱ级,按照随机分组的原则,将患者分为前锯肌平面阻滞组(SP组,n=20)和对照组(C组,n=20)。记录术后在PACU内舒芬太尼追加剂量及总用量、48 h内疼痛VAS评分、48 h内镇痛泵有效按压次数及总按压次数;记录功能锻炼依从性及慢性疼痛的发生率;记录患者局麻药中毒、皮下血肿、感染、皮肤瘙痒、头晕、恶心呕吐、尿潴留、便秘等不良反应的发生情况。结果与C组比较,SP组术后舒芬太尼追加剂量及总舒芬太尼用量明显减少(P<0.05);术后2、4、8、24、48 h疼痛VAS评分明显降低(P<0.05);48 h内PCIA有效按压次数及总按压次数明显减少(P<0.05);功能锻炼依从性明显较好(P<0.05)。两组慢性疼痛发生率差异无统计学意义。两组镇痛不良反应差异无统计学意义。结论对于非小细胞肺癌胸腔镜手术患者,前锯肌平面阻滞联合静脉自控镇痛的多模式镇痛可有效控制术后疼痛,减少镇痛药的用量、镇痛泵按压次数和慢性疼痛的发生率,提高患者呼吸功能锻炼的依从性。
Objective To investigate the analgesic effect of anterior serratus plane block for early stage non-small cell lung cancer(NSCLC) patients who undergoing thoracoscopic lobectomy. Methods From July to December in 2017, forty early stage NSCLC patients in our unit were enrolled, no gender limitation, aged 48-67 years, BMI 21.3-26.7 kg/m~2, falling into ASA physical status Ⅰ or Ⅱ, according to the principle of randomized control, 40 patients were then divided into anterior serratus plane block group(group SP, n=20) and control group(group C, n=20). Postoperative parameters such as sufentanil ensufix usage in post anesthesia care unit(PACU), pain score at 2, 4, 8, 24 and 48 h postoperatively, number of effective compressions and total number of compressions for patients-controlled intravenous analgesia(PCIA) pump, compliance of functional training and incidence of chronic pain were compared between the two groups. During PCIA, the occurrence of complications were recorded. Results Compared with group C, the supplemental dosage and total consumption of sufentanil in group SP were decreased(P<0.05). Meanwhile, the pain scores within 48 h in group SP has better advantage than those in group C(P<0.05), and the total number of compressions for PCIA were more limited in group SP. The compliance of functional exercise in group SP was also better. However, there was not different in the chronic pain scores and the proportion of adverse drug reaction between two groups. Conclusion For thoracoscopic lobectomy,anterior serratus plane block combining the patients-controlled intravenous analgesia(PCIA) can effectively control the postoperative acute pain, reduce the dosage of analgesic, PCIA pump press times and the incidence of postoperative chronic pain, thus promoting the compliance of functional exercise.
Objective To investigate the analgesic effect of anterior serratus plane block for early stage non-small cell lung cancer(NSCLC) patients who undergoing thoracoscopic lobectomy. Methods From July to December in 2017, forty early stage NSCLC patients in our unit were enrolled, no gender limitation, aged 48-67 years, BMI 21.3-26.7 kg/m~2, falling into ASA physical status Ⅰ or Ⅱ, according to the principle of randomized control, 40 patients were then divided into anterior serratus plane block group(group SP, n=20) and control group(group C, n=20). Postoperative parameters such as sufentanil ensufix usage in post anesthesia care unit(PACU), pain score at 2, 4, 8, 24 and 48 h postoperatively, number of effective compressions and total number of compressions for patients-controlled intravenous analgesia(PCIA) pump, compliance of functional training and incidence of chronic pain were compared between the two groups. During PCIA, the occurrence of complications were recorded. Results Compared with group C, the supplemental dosage and total consumption of sufentanil in group SP were decreased(P<0.05). Meanwhile, the pain scores within 48 h in group SP has better advantage than those in group C(P<0.05), and the total number of compressions for PCIA were more limited in group SP. The compliance of functional exercise in group SP was also better. However, there was not different in the chronic pain scores and the proportion of adverse drug reaction between two groups. Conclusion For thoracoscopic lobectomy,anterior serratus plane block combining the patients-controlled intravenous analgesia(PCIA) can effectively control the postoperative acute pain, reduce the dosage of analgesic, PCIA pump press times and the incidence of postoperative chronic pain, thus promoting the compliance of functional exercise.
引文
[1] 邱萍萍,康明强,李伟.肺癌术后患者康复锻炼依从性与疲乏、疼痛的相关性研究.护理学杂志,2014,29(2):21-23.
[2] 成燕,童莺歌,刘敏君,等.手术后患者活动性疼痛的护理评估现状.中国实用护理杂志,2015,31(7):481-485.
[3] Blanco R,Parras T,McDonnell JG,et al.Serratus plane block:a novel ultrasound-guided thoracic wall nerve block.Anaesthesia,2013,68(11):1107-1113.
[4] 韩超,任鸿飞,周敏敏,等.超声引导下前锯肌平面阻滞对乳腺癌根治术患者术后镇痛的影响.临床麻醉学杂志,2016,32(12):1173-1176.
[5] Mongardon N,inton-Gonnet C,Szekely B,et al.Assessment of chronic pain after thoracotomy:a 1-year prevalence study.Clin J Pain,2011,27(8):677-681.
[6] 薛照静,黄宇光,赵晶,等.慢性术后疼痛研究进展.中国疼痛杂志,2013,19(11):685-689.
[7] Gilron I,Tod D,Goldstein DH,et a1.The relationship between movement-evoked versus spontaneous pain and peak expiratory flow after abdominal hysterectomy.Anesth Analg,2002,95(6):1702-1707.
[8] 宋金玲,孙立新,王明山.椎旁神经阻滞或硬膜外阻滞复合全麻对开胸手术炎性反应的影响.临床麻醉学杂志,2013,29(5):472-474.
[9] 黎吉娜,黄伶智,李乐之,等.肺癌患者术后呼吸功能锻炼依从性及动画宣教需求调查.中华现代护理杂志,2016,22(34):4976-4978.
[10] 黄丽,王晓霞,张娟.回馈教学对食管癌开胸手术患者呼吸功能锻炼依从性的研究.中华护理杂志,2016,51(1):26-28.
[11] Corrigan PP.Compact clinical guide to acute pain management:an evidence-based approach for nurses.Nurse Educ Pract,2012,12(4):e29.
[12] 冯慧,李清,罗向红,等.食管癌根治手术围术期多模式镇痛的临床研究.重庆医学,2014,(29):3904-3906.
[13] Kim DH,Oh YJ,Lee JG,et al.Efficacy of ultrasound-guided serratus plane block on postoperative quality of recovery and analgesia after video-assisted thoracic surgery:a randomized,triple-blind,placebo-controlled study.Anesth Analg,2018,126(4):1353-1361.
[14] 孟杰,肖航,曾宪伟,等.超声引导下前锯肌平面阻滞对胸腔镜肺癌根治术术后镇痛及炎性反应的影响.临床肺科杂志,2018,23(5):913-916.
[15] 中国加速康复外科专家组.中国加速康复外科围手术期管理专家共识(2016).中华外科杂志,2016,54(6):413-418.
[16] ?kmen K,Metin ?kmen B.Evaluation of the effect of serratus anterior plane block for pain treatment after video-assisted thoracoscopic surgery.Anaesth Crit Care Pain Med,2018,37(4):349-353.
[17] 王海棠,刘薇,黄宇光.手术后慢性疼痛的研究进展.临床麻醉学杂志,2012,28(11):1131-1133.
[18] Takimoto K,Nishijima K,Ono M.Serratus plane block for persistent pain after partial mastectomy and axillary node dissection.Pain Physician,2016,19(3):E481-486.
[2] 成燕,童莺歌,刘敏君,等.手术后患者活动性疼痛的护理评估现状.中国实用护理杂志,2015,31(7):481-485.
[3] Blanco R,Parras T,McDonnell JG,et al.Serratus plane block:a novel ultrasound-guided thoracic wall nerve block.Anaesthesia,2013,68(11):1107-1113.
[4] 韩超,任鸿飞,周敏敏,等.超声引导下前锯肌平面阻滞对乳腺癌根治术患者术后镇痛的影响.临床麻醉学杂志,2016,32(12):1173-1176.
[5] Mongardon N,inton-Gonnet C,Szekely B,et al.Assessment of chronic pain after thoracotomy:a 1-year prevalence study.Clin J Pain,2011,27(8):677-681.
[6] 薛照静,黄宇光,赵晶,等.慢性术后疼痛研究进展.中国疼痛杂志,2013,19(11):685-689.
[7] Gilron I,Tod D,Goldstein DH,et a1.The relationship between movement-evoked versus spontaneous pain and peak expiratory flow after abdominal hysterectomy.Anesth Analg,2002,95(6):1702-1707.
[8] 宋金玲,孙立新,王明山.椎旁神经阻滞或硬膜外阻滞复合全麻对开胸手术炎性反应的影响.临床麻醉学杂志,2013,29(5):472-474.
[9] 黎吉娜,黄伶智,李乐之,等.肺癌患者术后呼吸功能锻炼依从性及动画宣教需求调查.中华现代护理杂志,2016,22(34):4976-4978.
[10] 黄丽,王晓霞,张娟.回馈教学对食管癌开胸手术患者呼吸功能锻炼依从性的研究.中华护理杂志,2016,51(1):26-28.
[11] Corrigan PP.Compact clinical guide to acute pain management:an evidence-based approach for nurses.Nurse Educ Pract,2012,12(4):e29.
[12] 冯慧,李清,罗向红,等.食管癌根治手术围术期多模式镇痛的临床研究.重庆医学,2014,(29):3904-3906.
[13] Kim DH,Oh YJ,Lee JG,et al.Efficacy of ultrasound-guided serratus plane block on postoperative quality of recovery and analgesia after video-assisted thoracic surgery:a randomized,triple-blind,placebo-controlled study.Anesth Analg,2018,126(4):1353-1361.
[14] 孟杰,肖航,曾宪伟,等.超声引导下前锯肌平面阻滞对胸腔镜肺癌根治术术后镇痛及炎性反应的影响.临床肺科杂志,2018,23(5):913-916.
[15] 中国加速康复外科专家组.中国加速康复外科围手术期管理专家共识(2016).中华外科杂志,2016,54(6):413-418.
[16] ?kmen K,Metin ?kmen B.Evaluation of the effect of serratus anterior plane block for pain treatment after video-assisted thoracoscopic surgery.Anaesth Crit Care Pain Med,2018,37(4):349-353.
[17] 王海棠,刘薇,黄宇光.手术后慢性疼痛的研究进展.临床麻醉学杂志,2012,28(11):1131-1133.
[18] Takimoto K,Nishijima K,Ono M.Serratus plane block for persistent pain after partial mastectomy and axillary node dissection.Pain Physician,2016,19(3):E481-486.
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