目的：探讨超声引导下胸椎旁神经阻滞在开腹胰十二指肠切除术（PD）中的镇痛效果。方法：选择43例行择期PD术患者，随机分为对照组（21例）和观察组（22例），对照组行单纯全身麻醉，观察组于全麻诱导前20 min在超声引导下于右侧T8-9、T11-12行两点椎旁阻滞，每点使用0.4%罗哌卡因10 mL，所有患者术后使用静脉自控镇痛泵（PCIA）。记录两组患者入室后、切皮前、切皮后5 min、手术结束前的平均动脉压（MAP）和心率（HR），术中舒芬太尼用量，术后48 h时镇痛泵按压次数，术后2、16、24、48 h安静和90°翻身时VAS评分，以及患者术后不良反应的发生率。结果：两组患者术前各项基线资料均无统计学差异（均P>0.05）。与对照组比较，观察组切皮后5 min时平均MAP（83 mmHg vs. 95 mmHg）和HR（77次/min vs. 87次/min）明显降低（均P<0.05），其余3个时间点无统计学差异（均P>0.05）；术后2、16、24 h安静与90°翻身平均VAS评分均明显降低（均P<0.05），而术后48 h无统计学差异（均P>0.05）；平均术中舒芬太尼用量（0.9 μg/kg vs. 1.5 μg/kg）、术后PCIA按压次数（13.1 次vs. 27.6次）均明显减少（均P<0.05）。两组恶心、呕吐、出汗、眩晕、瘙痒、谵妄等术后不良反应的发生率均无统计学差异（均P>0.05），两组均无呼吸抑制发生。结论：超声引导椎旁阻滞能显著减轻PD术中和术后患者的疼痛。
Analgesic efficacy of ultrasound guided thoracic paravertebral block in patients undergoing open pancreaticoduodenectomy
Objective: To investigate the analgesic efficacy of ultrasound guided thoracic paravertebral block during open pancreaticoduodenectomy (PD). Methods: Forty three patients scheduled for an elective open PD were randomly designated to control group (21 cases) and observation group (22 cases). Patients in control group underwent general anesthesia alone, and those in observation group underwent ultrasound guided paravertrbral block through injection of 10 mL of 0.4% ropivacaine each at right T8–9 and T11–12 interspaces 20 min before general anesthesia induction. Patient controlled intravenous analgesia (PCIA) was used in all patients after operation. Several variables were recorded, including the mean artery pressure (MAP) and heart rate (HR) at the times of just after entering the operation room, before skin incision, 5 min after skin incision and shortly before the end of operation, the amount of intraoperative sulfentanil consumption, PCIA compress frequency within 48 h after operation, the visual analogue score (VAS) both during resting state and 90° body turning over at 2, 16, 24 and 48 h after operation, and the occurrence of adverse reactions. Results: There were no differences in baseline data between the two groups of patients (all P>0.05). In observation group compared with control group, the average MAP (83 mmHg vs. 95 mmHg) and HR (77 beats/min vs. 87 beats/min) at 5 min after skin incision were significantly decreased (both P<0.05), but showed no significant difference at the other 3 time points (all P>0.05), the average VAS scores at resting state and 90° body turning over were significantly reduced at 2, 16 and 24 h after operation (all P<0.05), but showed no significant differences at 48 h after operation (both P>0.05), and the average amount of intraoperative sulfentanil consumption (0.9 μg/kg vs. 1.5 μg/kg) and PCIA requirements (13.1 times vs. 27.6 times) were significantly decreased (both P<0.05). No significant differences were noted in the adverse reactions such as postoperative nausea, vomiting, sweating, dizziness, itching and delirium between the two groups (all P>0.05), and no respiratory depression occurred in either group. Conclusion: Ultrasound guided thoracic paravertebral block provides a remarkable pain relief effect for patients during and after open PD.