胸椎旁神经阻滞在胸腔镜肺叶切除术中的应用:随机对照试验

Application of thoracic paravertebral nerve block in video-assisted thoracosopic surgery:a randomized controlled trial

目的探讨罗哌卡因复合舒芬太尼单次胸椎旁神经阻滞(TPVB)对胸腔镜下肺叶切除术手术患者疼痛及快速康复的影响。方法择期行胸腔镜下肺叶切除手术患者60例,随机分为3组:单纯静吸复合全麻组(C组)、罗哌卡因单次预先胸椎旁神经阻滞+静吸复合全麻组(T1组)、罗哌卡因复合舒芬太尼单次预先胸椎旁神经阻滞+静吸复合全麻组(T2组)。3组术后均不采用术后镇痛装置,若术后NRS评分>4分,则给予盐酸曲马多注射液100 mg肌肉注射补救镇痛,并记录3组术前(神经阻滞用药)、术中静脉用舒芬太尼、舒芬太尼总量(静脉+神经阻滞)、静脉用瑞芬太尼的总量,术后4、6、24、48 h NRS评分,术后24 h内是否补救镇痛、手术后入ICU停留时间以及术后住院时间。结果与C组相比,T1、T2组的术中静脉用舒芬太尼量、舒芬太尼总量(静脉+神经阻滞)、静脉用瑞芬太尼的总量明显减少(aP<0.05),术后4、6、24 h的NRS评分明显降低(P<0.05),手术后入ICU停留时间及术后住院时间明显缩短(P<0.05)。T1与T2组相比,后者术中静脉用阿片类药物总量较少(P<0.05),而舒芬太尼总量差异无统计学意义,术后4、6 h的NRS评分更低(P<0.05),而手术后入ICU停留时间及术后住院时间无明显差异。结论罗哌卡因复合舒芬太尼单次预先胸椎旁神经阻滞可以减少术中静脉用阿片类药物的总量,发挥最佳的镇痛效应,提供满意的早期术后镇痛;与单纯静吸复合麻醉相比,可以有效促进患者术后快速康复,但与单纯罗哌卡因用于TPVB相比,未见更多的优势,也许与该研究病例数有关。

Objective To investigate the effect of a single dose of ropivacaine combined with sufentanilfor thoracic paravertebral block(TPVB) on pain and enhanced recovery after surgery(ERAS) in patients undergoing video-assisted thoracosopic surgery.Methods Sixty patients undergoing video-assisted thoracosopic surgery were randomly divided into three groups to receive intravenous combined general anesthesia(group C), a single dose of ropivacainefor thoracic paravertebral block before surgery combined with intravenous and general anesthesia(group T1), or a single dose of ropivacaineand sufentanilfor thoracic paravertebral blockcombined with intravenous and general anesthesia(group T2). None of the patients used postoperative analgesia pump, and tramadol hydrochoride injection(100 mg) was given in cases with NRS scores > 4 after the surgery. The data were recorded including analgesics used for nerve block before the operation, intravenous dosage of sufentanilduring operation, total dose of sufentanilused(intravenous+nerve block), intravenous remifentanil dose during operation, NRS scores at 4, 6, 24, 48 h after the surgery, rescue analgesia in the first postoperative 24 h after surgery, ICU stay and hospital stay after the surgery. Results Compared with those in group C, the intravenous sufentanildose, total sufentanildose, intravenous remifentanildose during operation, NRS scores at 4 and 6, 24 h, and ICU stay and hospital stay after the surgery were significantly decreased in groups T1 and T2(P<0.05). The total dose of opioids during the operation and NRS scores at 4 and 6 h were significantly lower in group T2 than in group T1(P<0.05), but the total dose of sufentanil, ICU stay and hospital stay were simialr between the two groups. Conclusion A single dose of ropivacaine combined with sufentanilfor thoracic paravertebral blockbefore surgery can reduce the total dose opioids, produce the optimal analgesic effect, and promote postoperative recovery of the patients.