【罂粟摘要】不同剂量罗哌卡因对乳房手术患者前锯肌深平面阻滞的效果比较:一项前瞻性随机双盲试验
不同剂量罗哌卡因对乳房手术患者前锯肌深平面阻滞的效果比较:一项前瞻性随机双盲试验
贵州医科大学 高鸿教授课题组
翻译：安丽 编辑：佟睿 审校：曹莹
大剂量局麻药可造成更大范围的感觉阻滞，但风险也更大。本试验的目的是比较接受乳房手术的患者在前锯肌深平面注射不同体积罗哌卡因的效果。
在这项随机双盲试验中，60例接受乳腺手术的患者被随机分为R10、R20和R30组（n=20），分别接受10、20和30mL 0.5%罗哌卡因的深锯前平面阻滞。阻滞30分钟后，沿腋中线沿颅尾方向冷刺激测试皮肤感觉。记录术后24小时内疼痛数值评分，并通过数字评分量表疼痛评分估计曲线下面积。并记录了抢救镇痛的病例和不良事件的发生率。
R10组、R20组和R30组的阻滞皮肤范围分别为3[3,4]、6[5,7]和7[6,8]（R10组与R20组比较，P<0.001；R10与R30比较，P<0.001；R20对R30，P=0.005）。R10组的曲线下面积明显高于R20和R30组（静止时P=0.014，P=0.003；运动时，P<0.001，P<0.001）。
当使用10、20和30ml罗哌卡因进行深锯肌前平面阻滞时，阻滞的皮肤随着容量的增加而增加。20和30毫升的镇痛效果相似，优于10毫升。因此，在乳房手术中，20毫升罗哌卡因的容量被认为适合于深锯齿前平面阻滞。
Kejian Shi, Ying Chen, Le Liu,et al.Comparison of the effect of different volumes ropivacaine on deep serratus anterior plane block in patients undergoing breast surgery: a prospective randomized double-blinded trial.[J] Ann Palliat Med 2021;10(6):6104-6111.
Comparison of the effect of different volumes ropivacaine on deep serratus anterior plane block in patients undergoing breast surgery: a prospective randomized double-blinded trial
Abstract
Background: A larger volume of local anesthetic provides a wider range of blocked sensory but carries a greater risk. The purpose of this trial was to compare the effect of different volumes of ropivacaine injected to deep serratus anterior plane in patients undergoing breast surgery.
Methods: In this randomized double-blind trial, 60 patients undergoing breast surgery were randomly allocated to R10, R20 and R30 groups (n=20), and received deep serratus anterior plane block with 10, 20 and 30 mL of 0.5% ropivacaine respectively. 30 minutes after block, the cutaneous sensory was tested by cold stimulus in the craniocaudal direction along the midaxillary line. We recorded the numerical rating scale pain scores over 24 h after surgery and estimated the area under curve by numerical rating scale pain scores. The cases of rescue analgesia and the prevalence of adverse events were also recorded.
Results:The blocked dermatomes were 3 [3, 4], 6 [5, 7] and 7 [6, 8] in the R10, R20 and R30 groups, respectively (R10 vs. R20, P<0.001; R10 vs. R30, P<0.001; R20 vs. R30, P=0.005). The area under curve of R10 group was significantly higher compared with the R20 and R30 groups (P=0.014, P=0.003, at rest; P<0.001, P<0.001, on movement).
Conclusions: The blocked dermatomes increased with increasing volume when 10, 20 and 30 mL ropivacaine was used for deep serratus anterior plane block. The analgesic effects of 20 and 30 mL were similar to each other and better than 10 mL. Therefore, in breast surgery, volume of 20 mL ropivacaine is considered to be appropriate for deep serratus anterior plane block.