超声引导下竖脊肌平面阻滞与胸椎旁神经阻滞对纵隔肿瘤切除患者术后镇痛效果对比研究

Comparative study of ultrasound-guided erector spinae plane block and thoracic paravertebral block on postoperative analgesia in patients undergoing mediastinal tumor resection

目的比较超声引导下竖脊肌平面阻滞(erector spinae plane block,ESPB)与胸椎旁神经阻滞(thoracic paravertebral block,TPVB)对胸腔镜下纵隔肿瘤切除患者术后镇痛效果。方法选择胸腔镜下纵隔肿瘤切除患者48例,随机分为ESPB组(E组)和TPVB(T组),麻醉诱导前分别行超声引导下ESPB和TPVB,术后均行PCIA(静脉自控镇痛)。记录神经阻滞操作时间,术中瑞芬太尼泵入量,血管活性药物剂量,平均动脉压和心率;记录术后48h内静息和动态VAS评分,镇痛泵按压次数,氟比洛芬酯用量,术后并发症和患者镇痛效果满意度。结果与T组相比,E组神经阻滞操作时间短,刺破胸膜发生率低(P<0.05)。两组患者术中平均动脉压和心率,48h内静息和动态VAS评分,镇痛泵按压次数,术中瑞芬太尼泵入量,术后氟比洛芬酯使用量,镇痛效果满意度差异无统计学意义(P>0.05)。结论ESPB操作简单,安全性高,可替代TPVB为纵隔手术患者提供良好的术后镇痛。

Objective To compare the postoperative analgesic efficacy of ultrasound-guided erector spinae plane block (ESPB) and thoracic paravertebral block (TPVB) in patients undergoing video-assisted thoracoscopic mediastinal tumor resection. Methods Forty-eight patients undergoing video-assisted thoracoscopic mediastinal tumor resection, were randomly divided into ESPB group (E group) and TPVB (T group). Ultrasound-guided ESPB and TPVB were performed in both groups before anesthesia induction, all patients received PCIA (patient-controlled intravenous analgesia) after operation. The operation time of nerve block, the dosage of remifentanil and vasoactive drugs during operation, the mean arterial pressure and heart rate were recorded. Static and dynamic pain scores at postoperative 48 hours were evaluated, the frequency of PCIA compressions, the consumption of flurbiprofen axetil, the postoperative complications and patients satisfaction with analgesic effect were analyzed as well. Results Compared with the T group, the operation time of the nerve block was shorter in the E group, and the incidence rate of pleural puncture was significantly lower (P< 0.05). There was no significant difference between two groups in the mean arterial pressure and heart rate (P> 0.05). The static and dynamic VAS scores within 48 hours, the number of analgesic pump presses, the dosage of remifentanil and flurbiprofen axetil, the patient satisfaction had no statistically significant difference between the two groups (P> 0.05). Conclusion ESPB is equally effective as TPVB in providing postoperative analgaesia in patients undergoing video-assisted thoracoscopic mediastinal tumor resection. ESPB is a simple operation and a better safe profile compared with TPVB.