超声引导下单次竖脊肌平面阻滞对胸腔镜肺叶切除患者术后镇痛的影响

Effect of ultrasound-guided single erector spine plane block for analgesia after video-assisted thoracoscopic surgery

目的探讨超声引导下单次竖脊肌平面阻滞(ESPB)对胸腔镜手术患者术后镇痛的效果。方法选择中国医科大学附属盛京医院2018年3—11月接受择期全身麻醉胸腔镜下肺叶切除术患者60例,按随机数字表法分为对照组与ESPB组,每组30例,全身麻醉诱导后于患侧行超声引导下单次竖脊肌平面阻滞,ESPB组注入0.375%罗哌卡因20 ml,对照组注入等量的0.9%氯化钠溶液,两组患者术后均给予静脉自控镇痛。术后1、2、4、8、12和24 h分别随访患者,记录各时间点的疼痛视觉模拟量表(VAS)评分,记录两组患者术后镇痛泵输注量、不良反应发生情况以及两组患者对于术后镇痛方案满意度评价。结果ESPB组VAS评分在术后1、2、4、8和12 h均低于对照组,差异有统计学意义(P<0.05)。ESPB组术后24 h内镇痛泵输注总量为(58.17±4.35)ml,少于对照组的(63.77±4.07)ml,差异有统计学意义(P<0.05)。两组不良反应发生率比较差异无统计学意义(P>0.05)。ESPB组术后对于术后镇痛方案的满意度评价高于对照组(P<0.05)。结论超声引导下单次竖脊肌平面阻滞能有效缓解胸腔镜手术后患者的疼痛,减少术后阿片类药物使用量,提高患者对于术后疼痛管理满意度。

Objective To investigate the effect of ultrasound-guided single erector spine plane block (ESPB) for analgesia after video-assisted thoracoscopic surgery. Methods Sixty participants who received video-assisted thoracoscopic surgery under general anaesthesia from March 2018 to November 2018 in Shengjing Hospital Affiliated of China Medical University were randomly allocated. Thirty patients were blocked with 20 ml ropivacaine 0.375%(ESPB group), and 30 patients were blocked with saline (control group). Each group received patient-controlled intravenous analgesia.The visual analogue scale (VAS) scroe at postoperative 1, 2, 4, 8, 12 and 24 h were recorded, the volume of analgesia drugs, adverse reaction and satisfaction degree were compared between two groups. Results The scores of VAS at postoperative 1, 2, 4, 8 and 12 h in ESPB group were significantly lower than those in control group, and there was significant difference (P < 0.05). The volume of analgesia drugs in ESPB group was significantly less than that in control group:(58.17 ± 4.35) ml vs.(63.77 ± 4.07) ml, P < 0.05. There was no significant difference in the adverse reaction rate (P > 0.05). The satisfaction degree in ESPB group was significantly higher than that in control group (P < 0.05). Conclusions Ultrasound-guided single ESPB for analgesia after video-assisted thoracoscopic surgery can effectively improve analgesia, reduce the the volume of analgesia drugs and increase the satisfaction degree.