超声引导竖脊肌平面阻滞用于胸腔镜肺叶切除术患者术后镇痛的效果：与胸椎旁神经阻滞比较

Efficacy of ultrasound-guided erector spinae plane block for postoperative analgesia in patients undergoing video-assisted thoracoscopic pulmonary lobectomy： a comparison with paravertebral nerve block

目的通过与胸椎旁神经阻滞比较，评价超声引导竖脊肌平面（ESP）阻滞用于胸腔镜肺叶切除术患者术后镇痛的效果。方法择期胸腔镜肺叶切除术患者90例，年龄18- 64岁，BMI 20-27 kg/m^2，ASA分级Ⅰ-Ⅲ级，性别不限。采用随机数字表法分为2组（n＝45）：超声引导胸椎旁神经阻滞组（P组）和超声引导ESP阻滞组（E组）。术毕前30 min，静脉注射吗啡0.1 mg/kg、帕瑞昔布钠40 mg。麻醉诱导结束后，P组和E组分别行超声引导患侧胸椎旁神经阻滞和ESP阻滞，均注入0.5%罗哌卡因20 ml。术毕接自控静脉镇痛泵，配方为0.1%吗啡100 ml，无背景剂量，PCA 1 ml，锁定时间8 min。每8 h静脉注射帕瑞昔布钠40 mg。记录手术时间、麻醉时间和术中瑞芬太尼总用量；记录患者神经阻滞操作时间及操作时刺破胸膜和血管损伤的发生情况。于术后2、4、6、24和48 h时记录患者吗啡累计用量。记录患者术后恶心呕吐、皮肤瘙痒和呼吸抑制的发生情况。VAS评分〉3分时肌肉注射曲马多100 mg进行补救镇痛。结果与P组比较，E组患者神经阻滞操作时间缩短（P〈0.05），2组患者术中瑞芬太尼总用量、吗啡累计用量、恶心呕吐发生率及补救镇痛率差异无统计学意义（P〉0.05）。2组患者均未发生刺破胸膜、血管损伤、皮肤瘙痒及呼吸抑制。结论超声引导ESP阻滞用于胸腔镜肺叶切除术患者术后镇痛效果优于胸椎旁神经阻滞。

Objective To evaluate the efficacy of ultrasound-guided erector spinae plane （ESP） block for postoperative analgesia in the patients undergoing video-assisted thoracoscopic pulmonary lobectomy by comparing with paravertebral nerve block.Methods Ninety patients of both sexes, aged 18-64 yr, with body mass index of 20-27 kg/m2, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, scheduled for elective video-assisted thoracoscopic pulmonary lobectomy, were divided into 2 groups （n=45 each） using a random number table： ultrasound-guided paravertebral nerve block （group P） and ultrasound-guided ESP block group （group E）. Morphine 0.1 mg/kg and parecoxib sodium 40 mg were intravenously injected at 30 min before surgery.Ultrasound-guided ESP and paravertebral nerve blocks were performed with 0.5% ropivacaine 20 ml after anesthesia induction in E and P groups, respectively.Both groups received patient-controlled intravenous analgesia with 0.1% morphine 100 ml after surgery, and the analgesia pump was set up with a 1 ml bolus dose, 8 min lockout interval and no background infusion.Parecoxib 40 mg was intravenously injected every 8 h. Operation time, anesthesia time and total consumption of intraoperative remifentanil were recorded.The operation time of nerve block and development of pleural puncture and vascular injury during operation were also recorded.The cumulative consumption of morphine was recorded at 2, 4, 6, 24 and 48 h after surgery.The development of postoperative nausea and vomiting and respiratory depression was recorded.Tramadol 100 mg was intramuscularly injected as a rescue analgesic when the visual analog scale score was more than 3.Results The operation time of nerve block was significantly shorter in group E than in group P （P〈0.05）. There was no significant difference in the total consumption of intraoperative remifentanil, cumulative consumption of morphine, incidence of nausea and vomiting or requirement for rescue analgesia between two groups （P〉0.05）. Pleural puncture, vascular injury, pruritus or respiratory depression was not found in two groups.Conclusion Ultrasound-guided ESP block provides better analgesic efficacy after operation than paravertebral nerve block in the patients undergoing video-assisted thoracoscopic pulmonary lobectomy.