优化气管切开术麻醉：神经阻滞的比较研究

IF 0.7 Q3 ANESTHESIOLOGY

Trends in Anaesthesia and Critical Care Pub Date : 2025-03-01 DOI:10.1016/j.tacc.2025.101541

Tarek I. Ismail , Rabab S.S. Mahrous , Ahmed A. Bedewy

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引用次数: 0

摘要

背景：气管切开术越来越多地作为一种计划手术用于广泛的适应症。虽然浅颈丛阻滞（SCPB）被广泛用于气管切开术的区域麻醉，但其在抑制喉反射方面的局限性可能导致不适和并发症。双侧SCPB联合双侧喉上神经阻滞（SLNB）可能通过减少气道反射来改善患者的预后。目的比较单用双侧SCPB与双侧SCPB联合双侧SLNB治疗镇静气管切开术患者的疗效。方法在亚历山大大学医院进行双盲、随机对照试验。120例需要择期气管切开术的成年患者，包括气管插管和非气管插管，随机分为两组：1组单独行超声引导下双侧SCPB， 2组双侧SCPB和双侧SLNB联合行超声引导下双侧SCPB。主要观察指标为术中咳嗽和喉痉挛的发生率。次要结局包括术后疼痛、累积止痛需求、到首次止痛要求的时间、术后并发症和患者满意度。结果2组（SCPB + SLNB）咳嗽和喉痉挛发生率明显低于1组(p <；0.05)。两组术后疼痛强度差异无统计学意义。此外，术后并发症和患者满意度在两组之间具有可比性，无显著差异。结论在SCPB中加入双侧SLNB可明显抑制气管切开术时气道相关反射。

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Optimizing tracheostomy anesthesia: A comparative study of nerve blocks

Background

Tracheostomy is increasingly performed as a planned procedure for a wide range of indications. While superficial cervical plexus block (SCPB) is widely used as regional anesthesia for tracheostomy, its limitation in suppressing laryngeal reflexes may lead to discomfort and complications. Combining bilateral SCPB with bilateral superior laryngeal nerve block (SLNB) could potentially improve patient outcomes by reducing airway reflexes.

Objective

This study aimed to compare the effectiveness of bilateral SCPB alone versus bilateral SCPB combined with bilateral SLNB in sedated patients undergoing surgical tracheostomy.

Methods

A double-blind, randomized controlled trial was conducted at Alexandria University Hospital. A total of 120 adult patients, both intubated and non-intubated, requiring elective tracheostomy was randomly allocated into two groups: Group 1 received an ultrasound-guided bilateral SCPB alone, while Group 2 received a combination of ultrasound-guided bilateral SCPB and bilateral SLNB. The primary outcome was the incidence of intraoperative coughing and laryngospasm. Secondary outcomes included postoperative pain, cumulative analgesic requirements, time to first analgesic request, postoperative complications and patients’ satisfaction.

Results

Group 2 (SCPB + SLNB) demonstrated a significantly lower occurrence of coughing and laryngospasm compared to Group 1 (p < 0.05). No significant difference was observed in postoperative pain intensity between the two groups. Additionally, postoperative complications and patients’ satisfaction were comparable between both groups, with no significant differences noted.