超声引导下单次竖脊肌平面阻滞用于老年患者术后镇痛的效果

Effect of ultrasound guided erector spinae plane block on postoperative analgesia in elderly patients

目的观察超声引导下单次竖脊肌平面阻滞(ESP)用于胸腔镜手术老年患者术后镇痛的效果。方法选择本院择期行胸腔镜手术的老年患者80例,男49例,女31例,年龄65～77岁,BMI 20～24kg/m2,ASAⅠ或Ⅱ级。随机分为ESP联合静脉镇痛组(E组)和静脉镇痛组(C组),每组40例。E组于麻醉诱导前行0.33%罗哌卡因+地塞米松5mg混合液30ml单次竖脊肌平面阻滞,C组不予处理,两组患者均采用全身麻醉。记录患者术后1、6、12、24和48h的静息和咳嗽时VAS评分和舒适度(BCS)评分。记录镇痛泵有效按压次数、输注总量和曲马多给药次数,记录患者对术后镇痛的满意度,记录皮肤瘙痒、头晕、胸闷等不良反应情况和气胸、局麻药中毒、内脏损伤、全脊麻等ESP相关并发症发生情况。结果与C组比较,E组术中丙泊酚和瑞芬太尼用量明显减少(P<0.05),不同时点静息和咳嗽时VAS评分明显降低(P<0.05),BCS评分明显升高(P<0.05),追加曲马多和镇痛泵有效按压次数明显减少(P<0.05),满意度评分明显升高(P<0.05)。两组皮肤瘙痒、头晕和胸闷等不良反应差异无统计学意义。两组患者均未见气胸、局麻药中毒、内脏损伤、全脊麻等ESP相关并发症。结论超声引导下单次竖脊肌平面阻滞可安全有效用于胸腔镜手术老年患者术后镇痛。

Objective To observe the effect of ultrasound guided erector spinae plane block(ESP) on postoperative analgesia in elderly patients undergoing thoracoscopic surgery.Methods Eighty patients undergoing thoracoscope surgery,49 males,31 females,age 65-77 years,BMI 20-24 kg/m2,falling into ASA physical status Ⅰ or Ⅱ,were randomly divided into two groups:erector spinae plane block combined with intravenous analgesia group(group E),intravenous analgesia group(group C),40 cases in each group.ESP was performed before the anesthesia induction at group E,and no nerve block in group C,the two groups of patients received general anesthesia.VAS score when resting and cough and comfort(BCS)score were also recorded at postoperative 1(T1),6(T2),12(T3),24(T4)and 48 h(T5).Number of analgesia pump pressure,infusion volume and number of tramadol medication,patients′satisfaction on postoperative analgesia,adverse reactions cases and the ESP related complications were documented.Results The difference of dosage of propofol and remifentanyl in the two groups was statistically significant(P <0.05),Compared with group C,VAS score(resting and cough)and additional tramadol were lower in group E and BCS score and satisfaction was higher(P <0.05).There was no statistically significant difference of itchy skin,dizziness,and chest tightness between the two groups.The two groups of patients did not have ESP related complications such as pneumothorax,visceral injury,nor did they encounter the whole spinal anesthesia and local anesthetics related complications.Conclusion Ultrasound guided ESP is safe and effective for postoperative analgesia in elderly patients undergoing thoracoscope surgery.