腔镜食管癌根治术中应用超声引导腹横肌平面阻滞联合胸椎旁或竖脊肌阻滞镇痛的效果

Effect of ultrasound guided transversus abdominis plane block combined with thoracic paravertebral block or erector spinae plane block in endoscopic esophagectomy

目的比较全身麻醉下腔镜食管癌根治术中应用超声引导下腹横肌平面阻滞联合胸椎旁或竖脊肌阻滞的镇痛效果。方法全身麻醉下行腔镜食管癌根治术患者60例,随机分为观察组29例和对照组31例。全身麻醉诱导前,2组在超声引导下经腹横肌注射质量分数0.375%罗哌卡因20 mL,之后观察组于T_5椎旁竖脊肌、对照组于T_5椎旁间隙注射质量分数0.375%罗哌卡因20 mL。记录2组手术时间,神经阻滞操作时间及操作相关血肿发生情况,术中舒芬太尼用量,苏醒时间,拔管时间以及术后2、4、6、12、24 h视觉模拟评分(visual analogue scale, VAS)评分,术后24 h补充镇痛比率,并进行比较。结果观察组神经阻滞操作时间[(12.6±2.6)min]较对照组[(19.1±2.1)min]短,操作相关血肿发生率(0)较对照组(19.35%)低(P<0.05);观察组手术时间[(520±18)min]、术中舒芬太尼用量[(44±4)μg]、麻醉苏醒时间[(2.8±0.9)min]、拔管时间[(3.9±0.5)min]、术后24 h补充镇痛比率(6.90%)与对照组[(516±20)min、(45±3)μg、(2.7±0.9)min、(3.8±0.6)min、6.45%]比较差异无统计学意义(P>0.05);观察组术后2、4、6、12、24 h VAS评分[(2.2±0.6)、(2.0±0.4)、(1.6±0.2)、(1.3±0.3)、(1.2±0.4)分]与对照组[(2.2±0.5)、(1.9±0.4)、(1.5±0.3)、(1.2±0.4)、(1.3±0.3)分]比较差异无统计学意义(P>0.05)。结论对行腔镜食管癌根治术患者,全身麻醉诱导前于超声引导下行腹横肌平面阻滞联合竖脊肌阻滞可取得与腹横肌平面阻滞联合胸椎旁阻滞相同的镇痛效果,且神经阻滞操作时间短,操作相关血肿发生率低。

Objective To compare the effect of ultrasound guided transversus abdominis plane combined with thoracic paravertebral block versus combined with erector spinae plane block in endoscopic esophagectomy.Methods Sixty patients scheduled for endoscopic esophagectomy under general anesthesia were randomly divided into observation group (n=19)and control group (n=31).Both groups received injection of 0.375% ropivacaine 20 mL via transversus abdominis under guidance of ultrasound before the induction of general anesthesia,followed by injection of 0.375% ropivacaine 20mL via erector spinae at T5in observation group and via thoracic paravertebral disc at T5in control group. The operative time,nerve block operating time,incidence of hematoma related to nerve block,dosage of sufentanil, anesthesia awake time,extubation time,VAS scores at 2,4,6,12and 24hafter operation,and rate of postoperative supplementary analgesia were recorded and compared between two groups.Results The nerve block operating time was significantly shorter and incidence of hematoma related to nerve block was significantly lower in observation group ((12.6±2.6)min,0)than that in control group((19.1±2.1)min,19.35%)(P<0.05).There were no significant differences in operative time((520±18)min),intraoperative sufentanil dosage((44±4)μg),anesthesia awake time ((2.8±0.9)min),extubation time((3.9±0.5)min),and postoperative supplementary analgesia rate(6.90%)in observation group compared with those in control group ((516±20)min,(45±3)μg,(2.7±0.9)min,(3.8± 0.6)min,6.45%)(P>0.05).VAS scores at 2,4,6,12and 24hafter operation in observation (2.2±0.5,1.9±0.4,1.5±0.3,1.2±0.4,1.3±0.3)(P>0.05).Conclusion In endoscopic esophagectomy,the analgesic effect of ultrasound guided transversus abdominis plane combined with erector spinae plane block is comparable to that of combined with thoracic paravertebral block,with shorter nerve block operating time and lower incidence of hematoma related to nerve block.