背景:最近已经描述了超声引导的上颌神经阻滞,尽管其对双颌骨截骨术的影响尚未得到正式研究。
目的:本研究旨在确定在双颌骨截骨术中增加超声引导的上颌神经阻滞是否能减少阿片类药物的使用。
■在2019年4月至2020年1月期间在Teknon医疗中心(巴塞罗那,西班牙)。
方法:预测变量是使用的治疗技术(上颌神经阻滞或不阻滞)。手术前将受试者随机分为接受(测试组)或不接受(对照组)双侧超声引导下的上颌神经阻滞(5ml0.37%罗哌卡因)。
■主要结果变量是术后前两个小时的静脉注射美沙酮需求。次要结果变量是术后疼痛,抢救皮下美沙酮,术中静脉注射瑞芬太尼,术后恶心呕吐的发生率,上颌神经阻滞引起的并发症。
■受试者年龄,性别,体重,高度,麻醉风险,并记录手术时间。
方法:使用χ2检验和Mann-WhitneyU检验进行描述性和推断性分析。对于P<0.05,认为有统计学意义。
结果:基线样本包括68名进行双颌骨截骨术的受试者。随访样本包括60名受试者:对照组30名(10名女性和20名男性,年龄34.0±10.2岁),试验组30岁(13名女性,17名男性,年龄29.8±10.8岁)。接受上颌神经阻滞的受试者在术后前2小时内静脉使用美沙酮较少(中位2.0mg对照组与0mg测试组;P<.001),术后18小时内任何时间的疼痛水平均较低(对照组与对照组相比,对照组与试验组的中位视觉模拟评分为2;P<.001),在手术后4-18小时,需要美沙酮的百分比较低(对照组为33.3%,实验组为0%;P<0.01)。
结论:获得的结果表明,超声引导上颌神经阻滞是一种有前途的麻醉技术,能够减少术中和术后阿片类药物的使用,在双颌骨截骨术中具有更大的患者舒适度。
Ultrasound-guided maxillary nerve block has recently been described, though its impact upon bimaxillary osteotomy has not been formally investigated.
The present study was carried out to determine whether the addition of ultrasound-guided maxillary nerve block in subjects undergoing bimaxillary osteotomy reduces opioid use.
A randomized clinical trial was carried out in adults undergoing bimaxillary osteotomy between April 2019 and January 2020 at Teknon Medical Center (Barcelona, Spain).
The predictor variable was the treatment technique used (maxillary nerve block or no block). The subjects were randomized to either receive (test group) or not receive (control group) bilateral ultrasound-guided suprazygomatic maxillary nerve block (5 ml of 0.37% ropivacaine) before surgery.
The primary outcome variable was the intravenous methadone requirements in the first two postoperative hours. The secondary outcome variables were postoperative pain, rescue subcutaneous methadone, intravenous remifentanil used intraoperatively, the incidence of postoperative nausea-vomiting, and complications derived from maxillary nerve block.
Subject age, sex, weight, height, and anesthetic risk, and the duration of surgery were recorded.
Descriptive and inferential analyses were performed using the χ2 test and Mann-Whitney U test. Statistical significance was considered for P < .05.
The baseline sample consisted of 68 subjects scheduled for bimaxillary osteotomy. The follow-up sample comprised 60 subjects: 30 in the control group (10 females and 20 males, aged 34.0 ± 10.2 years) and 30 in the test group (13 females and 17 males, aged 29.8 ± 10.8 years). The subjects who received maxillary nerve block showed less intravenous methadone use in the first 2 hours postsurgery (median 2.0 mg control group vs 0 mg test group; P < .001), lower pain levels at any time during the first 18 hours postsurgery (median visual analog score 4 control group vs 2 test group; P < .001), and a lesser percentage required methadone (33.3% control group vs 0% test group; P < .01) at 4-18 hours postsurgery.
The results obtained suggest that ultrasound-guided maxillary nerve block is a promising anesthetic technique capable of reducing intraoperative and postoperative opioid use, with greater patient comfort in bimaxillary osteotomy.