胸椎椎旁神经阻滞麻醉可缓解乳腺癌手术患者疼痛
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Thoracic paravertebral regional anesthesia for pain relief in patients with breast cancer surgery
背景与目的
本研究的目的是评估乳腺癌手术患者行胸椎旁神经阻滞麻醉（TPVBRA）的有效性和安全性。
方 法
将72例乳腺癌手术患者随机分为干预组和对照组，每组36例。两组均接受20ml 0.25%布比卡因行TPVBRA。此外，干预组受试者还接受了1mg/kg右美托咪啶。评估心率（HR）、收缩压（SBP）、舒张压（DBP）、疼痛强度（视觉模拟评分法、VAS）和镇痛消耗量，并记录不良事件。
结 果
在手术开始后30分钟，2组之间的HR（P＜0.05）、SBP（P＜0.05），DBP（P＜0.05）存在明显差异。此外，干预组比对照组的首次使用镇痛药物的时间更长（P = 0.043），而且镇痛药物的平均消耗量也更少（P = 0.035）。然而，在任何时间点，HR和VAS在两组之间无统计学差异（P＞0.05）。此外，两组不良反应发生情况相似（P＞0.05）。
结 论
这项研究的结果表明，联合布比卡因和右美托咪定进行TPVBRA能够提高镇痛的时间和质量，同时没有严重不良事件的发生。
原始文献摘要
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 efficacy 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:Significant 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 first 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 significant 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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