改良式罗哌卡因肋间神经阻滞在胸腔镜手术中的应用

Improved intercostal nerve block with ropivacaine in video-assisted thoracic surgery

目的:比较胸腔镜手术后不同途径给予罗哌卡因肋间神经阻滞对患者术后镇痛效果。方法:选取2018年8月至2018年11月天津医科大学肿瘤医院60例接受胸腔镜手术治疗的肺癌患者,手术结束时使用0.25%罗哌卡因阻滞肋间神经,采用改良式胸腔外经胸壁阻滞(试验组)和传统式胸腔内阻滞(对照组)。观察手术后12 h(T1)、24 h(T2)、48 h(T3)及72 h(T4)时两组患者静息时疼痛VAS评分及疼痛评分(Prince Henry Pain Scale,PHPS);同时观察手术后追加吗啡剂量和相关不良反应事件。结果:两组患者术后镇痛效果均较满意,试验组术后T1~T4各时间点VAS和P-H疼痛评分均无显著性差异(P>0.05),术后吗啡用量及带管时间两组无显著性差异(P>0.05),试验组在穿刺后胸膜下血肿发生例数较少。结论:胸腔镜下改良式罗哌卡因肋间神经阻滞与传统式胸腔内阻滞均能起到术后较好镇痛效果,改良式肋间神经阻滞的方法具有操作简便,并发症少的优点。

Objective: To compare two methods of injecting ropivacaine as an intercostal nerve blocker, and for postoperative pain control after video-assisted thoracic surgery(VATS) in lung cancer patients. Methods: From August 2018 to November 2018, 60 patients who had undergone VATS with a diagnosis of lung cancer, were randomly assigned into two groups: control and test. After the surgery, the control group was injected with an intercostal nerve blocker(0.25% ropivacaine) via the inner thorax by the traditional method, and the test group was injected with ropivacaine via the outer thorax by an improved method. The pain scale was evaluated using the Visual Analogue Scale(VAS) and Prince Henry Pain Scale(PHPS) at 12 h(T1), 24 h(T2), 48 h(T3), and 72 h(T4) after the surgery. The dosage of administered morphine and the adverse effects of ropivacaine after surgery were also evaluated. Results: Injecting ropivacaine to the intercostal nerve by means of both, outer and inner thoracic injection showed satisfied analgesia, as evaluated by VAS and PHPS scores, and there were no significant differences between the two methods at any time point of analysis(T1-T4, P>0.05). The dosage of administered morphine and the time with chest tube were similar(P>0.05) between the groups. However, there were a few cases of subpleural hemorrhage in the test group. Conclusions: Intercostal nerve block with ropivacaine by means of both, outer and inner thoracic injection, showed satisfied analgesia,although, outer thoracic injection is more flexible with fewer complications.