背景:用自体肋软骨(ACC)进行鼻成形术后,胸部剧烈疼痛。超声引导下(USG)锯齿肌前平面阻滞(SAPB),结合胸骨旁阻滞(PSB),早些时候报道,在缓解与胸前外侧手术相关的疼痛方面非常有效。然而,尚不清楚ACC收获后是否有效缓解疼痛。
方法:64名患者,18至60岁,接受ACC隆鼻手术,随机分为SAPB+PSB或SAPB组。两组的分析参数包括术后2、4、8、12、24和48小时胸部的休息和咳嗽数字评分(NRS)疼痛评分和鼻子的NRS疼痛评分,口服救护镇痛药的用法,副作用发生率和患者满意度,等。结果:每组30例患者纳入分析。SAPB+PSB组术后2、4、8、12h胸部休息和咳嗽NRS评分和鼻部NRS评分较低,与SAPB组比较(均P<0.05)。然而,术后24h和48h两组评分具有可比性(均P>0.05)。此外,相对于SAPB组,口服救护镇痛药使用率明显降低(P<0.05),术后恶心呕吐(PONV)发生率降低(P<0.05),SAPB+PSB组患者满意度明显高于对照组(P<0.001)。
结论:USG-SAPB,结合改进的PSB,在缓解ACC隆鼻术后疼痛方面优于单纯SAPB。
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Rhinoplasty with autologous costal cartilage (ACC) is followed by severe pain in the chest. Ultrasound-guided (USG) serratus anterior plane block (SAPB), in combination with parasternal block (PSB), was earlier reported to be highly efficacious in relieving pain associated with thoracic anterior lateral surgery. However, it is unclear whether it is effective for pain relief after ACC harvest.
Sixty-four patients, aged 18 to 60, who received rhinoplasty with ACC, were randomly separated into a SAPB+PSB or SAPB group. The analyzed parameters of both groups included the rest and coughing numerical rating scale (NRS) pain scores of the chest and the NRS pain scores of the nose at postoperative 2, 4, 8, 12, 24, and 48 hours, oral rescue analgesic usage, side effect incidence and patient satisfaction, etc. RESULTS: Thirty patients per group were recruited for analysis. The rest and coughing NRS scores of the chest and the NRS scores of the nose at postoperative 2, 4, 8, 12 h were lower in the SAPB+PSB group, compared to the SAPB group (all P < 0.05). However, these scores were comparable between the two groups at postoperative 24 and 48 h (all P > 0.05). Additionally, relative to the SAPB group, the oral rescue analgesic usage was drastically lower (P < 0.05), the postoperative nausea and vomiting (PONV) incidence was diminished (P < 0.05), and the patient satisfaction was markedly higher (P < 0.001) in the SAPB+PSB group.
USG-SAPB, in combination with improved PSB, is superior to SAPB alone in relieving pain after ACC harvest in rhinoplasty.
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