胸椎椎旁神經阻滯麻醉可緩解乳腺癌手術患者疼痛

Thoracic paravertebral regional anesthesia for pain relief in patients with breast cancer surgery

背景與目的

本研究的目的是評估乳腺癌手術患者行胸椎旁神經阻滯麻醉（TPVBRA）的有效性和安全性。

方 法

將72例乳腺癌手術患者隨機分為乾預組和對照組，每組36例。兩組均接受20ml 0.25%布比卡因行TPVBRA。此外，乾預組受試者還接受了1mg/kg右美托咪啶。評估心率（HR）、收縮壓（SBP）、舒張壓（DBP）、疼痛強度（視覺模擬評分法、VAS）和鎮痛消耗量，並記錄不良事件。

結 果

在手術開始後30分鐘，2組之間的HR（P＜0.05）、SBP（P＜0.05），DBP（P＜0.05）存在明顯差異。此外，乾預組比對照組的首次使用鎮痛藥物的時間更長（P = 0.043），而且鎮痛藥物的平均消耗量也更少（P = 0.035）。然而，在任何時間點，HR和VAS在兩組之間無統計學差異（P＞0.05）。此外，兩組不良反應發生情況相似（P＞0.05）。

結 論

這項研究的結果表明，聯合布比卡因和右美托咪定進行TPVBRA能夠提高鎮痛的時間和質量，同時沒有嚴重不良事件的發生。

原始文獻摘要

Jin LJ, Wen LY, Zhang YL, Li G, Sun P, Zhou X. Thoracic paravertebral regional anesthesia for pain relief in patients with breast cancer surgery, Medicine (Baltimore). Sep 2017;96(39):e8107. doi:10.1097/MD.0000000000008107.

BACKGROUND AND OBJECTIVES:The present study aimed to assess the ef?cacy and safety of thoracic paravertebral regional anesthesia (TPVBRA) in patients with breast cancer surgery.

METHODS:In total, 72 patients undergoing breast cancer surgery were randomly divided into an intervention group and a control group; each group contained 36 subjects. Both groups received TPVBRA with 20 m L 0.25% bupivacaine. In addition, subjects in the intervention group also received an additional 1 mg/kg dexmedetomidine. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), pain intensity (measured by visual analogue scale, VAS), and analgesic consumption were assessed; adverse events were also recorded.

RESULTS:Signi?cant differences were observed in HR (P < 0.05), SBP (P < 0.05), and DBP (P < 0.05) at the 30-minute point during surgery between the 2 groups. In addition, the time of the ?rst administration of analgesia (P = 0.043) and the mean consumption of analgesic agents (P = 0.035) in the intervention group were much better than those in the control group. However, no signi?cant differences in HR or VAS were found at any time point after surgery (P > 0.05). Furthermore, similar adverse events were detected in both groups (P > 0.05).

CONCLUSION:The results of this study showed that TPVBRA combined with bupivacaine and dexmedetomidine can enhance the duration and quality of analgesia without serious adverse events.

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