[Comparison of ultrasound-guided serratus anterior plane block and erector spinae plane blockperioperatively in radical mastectomy]
- PMID: 31207693
- DOI: 10.3760/cma.j.issn.0376-2491.2019.23.012
[Comparison of ultrasound-guided serratus anterior plane block and erector spinae plane blockperioperatively in radical mastectomy]
Abstract
Objective: To compare the perioperative effects of ultrasound-guided serratus anterior plane block (SAPB) and erector spinae plane block (ESPB) in radical mastectomy. Methods: One hundred and fifty patients,undergoing radical mastectomy from May 2016 to Jan 2019,the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, were randomly divided into SAPB group, ESPB group and control group. Patients in SAPB group and ESPB group were received corresponding blocks before induction of general anesthesia. The control group was only received routine general anesthesia without any block. Patient-controlled intravenous analgesia (PCIA) was performed in all the patients postoperatively. The VAS score at rest or coughing and Ramsay score at 2, 4, 8, 12, 24, 48 h after operation were compared among the three groups. The intraoperative dosages of propofol and remifentanil,press times and sufentanil cumulative dosage of PCIA in 48 hours after operation, postoperative rehabilitation indicators and adverse effects were all compared. Results: In all the three groups,the VAS scores at rest and coughing increased first and then decreased 2 h to 48 h after operation. The VAS scores in SAPB group and ESPB group were lower than that in control group (P<0.05), whereas, no significant difference was observed between SAPB group and ESPB group (P>0.05). For Ramsay score, among the three groups, there were no significances of the main effects of group and time point, as well as interaction effect (all P>0.05). The intraoperative dosages of propofol and remifentanil in SAPB group and ESPB group were lower than those in control group (P<0.05), the press times and sufentanil cumulative dosage of PCIA after operation were also lower than those in control group (P<0.05). There was no significant difference in feeding time after operation among the three groups (P>0.05). The times of first anal exhaust, ambulation and hospitalization after operation in ESPB group and SAPB group were significantly shorter than those in control group (P<0.05). However, there was no significant difference between ESPB group and SAPB group in postoperative rehabilitation indicators mentioned above (P>0.05). The incidences of skin itching and nausea in ESPB and SAPB groups were lower than those in control group (P<0.05). There was no difference in the incidence of vomiting among the three groups (P>0.05). Conclusions: Both SAPB and ESPB can provide good and safe analgesia for radical mastectomy,with equivalent performances in analgesia and adverse effect.
目的： 比较超声引导下前锯肌平面阻滞（SAPB）和竖脊肌平面阻滞（ESPB）在乳腺癌根治术围术期应用的效果。 方法： 2016年5月至2019年1月在温州医科大学附属第二医院接受乳腺癌根治术治疗的150例患者，随机数字表法分为SAPB组、ESPB组和对照组，每组50例。在常规全身麻醉基础上，SAPB组行前锯肌平面阻滞，ESPB组行竖脊肌平面阻滞，术后给予患者自控静脉镇痛（PCIA）。比较3组术后2、4、8、12、24、48 h静息与咳嗽时采用视觉模拟评分（VAS）及Ramsay镇静评分；比较3组患者术中丙泊酚及瑞芬太尼用量、术后48 h PCIA镇痛按压次数、PCIA舒芬太尼用量、术后早期康复指标及不良反应。 结果： 3组患者术后2 h到术后48 h的静息VAS评分和咳嗽时VAS评分先升高后下降，SAPB组和ESPB组VAS评分显著低于对照组（均P<0.05），SAPB组和ESPB组间差异无统计学意义（P>0.05）；3组患者Ramsay评分在组间、时间点、组间-时间点交互效应比较差异均无统计学意义（均P>0.05）。SAPB组和ESPB组术中丙泊酚用量、瑞芬太尼用量显著低于对照组，术后PCIA镇痛按压次数和PCIA舒芬太尼用量均显著低于对照组（均P<0.05）；3组患者术后进食时间差异无统计学意义（P>0.05），ESPB组和SAPB组首次肛门排气时间、下床时间、术后住院时间均显著短于对照组（均P<0.05），皮肤瘙痒和恶心发生率显著低于对照组（均P<0.05），ESPB组和SAPB组比较差异无统计学意义（P>0.05）。 结论： SAPB和ESPB均能为乳腺癌根治术患者提供良好、安全的镇痛，两者镇痛效果和不良反应相当。.
Keywords: Analgesia; Breast neoplasms; Nerve block; Ultrasonography,doppler.
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