背景:氢吗啡酮与罗哌卡因联合应用于超声引导下的竖脊肌平面阻滞可增强乳腺手术患者的术后镇痛效果并降低白细胞介素-6的表达。
方法:在本研究中,乳腺癌改良根治术患者随机分为3组(每组30例):标准一般(C组),罗哌卡因平立脊柱平面阻滞(ESPB)(R组),和ESPB与罗哌卡因加氢吗啡酮(HR组)。诊断:乳腺癌患者。手术后,疼痛程度,IL-6,麻醉剂量,额外的镇痛需求,和恢复里程碑进行比较,以评估ESPB增强的疗效.
结果:3组基线特征无显著差异,操作时间,术后恶心的例数,和T1时(手术后返回病房的时间)的血清IL-6浓度。在T2(手术后第二天早上6:00),HR组血清IL-6浓度显著低于R组和C组(P<0.05);舒芬太尼,HR和R组的丙泊酚明显低于C组(P<0.05);HR和R组的视觉模拟评分在T3(术后4小时)明显降低,T4(术后12小时),和T5(术后24小时)高于C组(P<0.05);HR组和R组接受术后镇痛的患者比例明显低于C组(P<0.05);HR组和R组术后恶心的患者比例明显低于C组(P<0.05);HR组和R组术后第一次肛门排气时间和术后第一次下床活动时间明显短于C组(P<0.05)。
结论:氢吗啡酮复合罗哌卡因对全麻下MRM患者的术后镇痛效果更好。联合镇痛引起的不良反应少,抑制炎症因子IL-6的表达水平,从而促进术后恢复。使用氢吗啡酮和罗哌卡因的ESPB改善MRM后疼痛控制,减少不利影响,更有效地抑制IL-6,促进恢复。
BACKGROUND: Combining hydromorphone with ropivacaine in ultrasound-guided erector spinae plane blocks enhances postoperative analgesia and reduces interleukin-6 expression in breast surgery patients.
METHODS: In this study, breast cancer patients undergoing modified radical mastectomy were randomized into 3 groups for anesthesia (30 patients in each group): standard general (group C), Erector Spinae Plane Block (ESPB) with ropivacaine (group R), and ESPB with ropivacaine plus hydromorphone (group HR). Diagnosis: Breast cancer patients. Postsurgery, pain levels, IL-6, anesthetic doses, additional analgesia needs, and recovery milestones were compared to evaluate the efficacy of the ESPB enhancements.
RESULTS: The 3 groups were not significantly different in baseline characteristics, operation time, number of cases with postoperative nausea, and serum IL-6 concentrations at T1 (the time of being returned to the ward after surgery). At T2 (at 6:00 in the next morning after surgery), the serum IL-6 concentration in group HR was significantly lower than that in groups R and C (P < .05); the intraoperative doses of remifentanil, sufentanil, and propofol were significantly lower in groups HR and R than those in group C (P < .05); Groups HR and R had significantly lower visual analog scale scores at T3 (4 hours postoperatively), T4 (12 hours postoperatively), and T5 (24 hours postoperatively) than those in group C (P < .05); the proportions of patients receiving postoperative remedial analgesia were significantly lower in groups HR and R than in group C (P < .05); groups HR and R had significantly lower proportions of patients with postoperative nausea than group C (P < .05); the time to the first anal exhaust and the time to the first ambulation after surgery were significantly shorter in groups HR and R than those in group C (P < .05).
CONCLUSIONS: Hydromorphone combined with ropivacaine for ESPB achieved a greater postoperative analgesic effect for patients receiving MRM under general anesthesia. The combined analgesia caused fewer adverse reactions and inhibited the expression level of the inflammatory factor IL-6 more effectively, thereby facilitating postoperative recovery. ESPB using hydromorphone with ropivacaine improved pain control post-MRM, reduced adverse effects, and more effectively suppressed IL-6, enhancing recovery.