| Objective:To study the analgesic effect of ultrasound-guided intermediate cervical plexus block(ICPB)combined with pectoserratus plane block(PSPB)for transaxillary endoscopic thyroidectomy.Methods:Twenty-four patients,aged 18-65 years,with BMI 18-30 Kg/m~2and ASA class I or II,undergoing thyroid surgery with TAET under general anesthesia electively from February 2022 to February 2023 were included.By using a random number table,the patients were randomly divided into two groups in the ratio of 1:1:nerve block group(Group N):ICPB(0.3%ropivacaine 8ml)combined with PSPB(0.375%ropivacaine 20ml);control group(Group C):general anesthesia only group.All patients routinely fasted from food and water before surgery and no preoperative medication was given.After being admitted to the operating room,patients received cardiac and blood pressure oximetry monitoring,and peripheral intravenous access was established.After induction of general anesthesia,ultrasound-guided ICPB combined with PSPB was performed in group N,and no nerve block was performed in group C.Intraoperative total intravenous anesthesia was taken.Four mg of ondansetron was given intravenously 15 minutes prior to the end of surgery to prevent postoperative nausea and vomiting(PONV),and tramadol was given for analgesia.At the end of the surgery,the infusion of anesthetic drugs was stopped,and the patient was removed from the tracheal tube and transferred to the postanesthesia care unit after satisfactory recovery of consciousness and spontaneous breathing.At 1h,6h,12h,and 24h postoperatively,the patient’s level of neck and axillary pain was then determined using the visual analogue scale(VAS),which required the patient to be fully conscious and was scored at rest and during movement.VAS score,0:no pain;1-3:mild pain,tolerable;4-6:pain with sleep disturbance,moderately tolerable;7-10:more intense pain,severe or unbearable pain.If the postoperative VAS score exceeds 4 points,the remedial analgesic flurbiprofen axetil injection was given.The number of patients requiring remedial analgesics after surgery and the incidence of PONV in both groups were recorded.Patients were scored for analgesic satisfaction 48h postoperatively on a scale of 0 to 10,with 0 being unsatisfactory and 10 being very satisfactory.Results:1.There was no statistically significant difference between the two groups in terms of age,gender,height,weight,body mass index(BMI),duration of anesthesia,and duration of surgery(P>0.05).2.Compared to the group C,patients in the group N had lower VAS scores in the neck and axilla during movement at 1,6,12,and 24 h postoperatively and lower VAS scores in the neck and axilla at rest at 1,6and 12h postoperatively(P<0.05).3.Patients in group N had a lower median intraoperative dose of remifentanil of 0.66 mg(interquartile range,0.51,0.79)compared with0.78 mg(interquartile range,0.55,0.95)in group C,however,this did not reach statistical significance(P=0.47).During the 48-hour monitoring period,the occurrence of postoperative nausea and vomiting was 8.3%and 25%in each group,respectively.Only one postoperative remedial analgesic was required in group N compared to two in group C.In addition,there was more patient satisfaction in the N group(P=0.005).There were no surgical or anesthetic complications for the duration of the research.Conclusion:Ultrasound-guided intermediate cervical plexus block combined with pectoserratus plane block significantly reduces postoperative pain and improves patient satisfaction during transaxillary endoscopic thyroidectomy. |
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