超声引导下椎板阻滞对胸腔镜下肺叶切除术术后镇痛的影响

Effects of ultrasound?guided retrolaminar block on postoperative analgesia in patient undergoing video?assisted thoracoscopic lobectomy

目的观察超声引导下椎板阻滞对胸腔镜下肺叶切除术患者术后镇痛效果的影响。方法择期行胸腔镜下肺叶切除术的患者40例,采用随机数字表法将患者分为两组(每组20例):椎板阻滞复合全身麻醉组(R组)和单纯全身麻醉组(G组)。R组患者全身麻醉前实施超声引导下椎板阻滞,阻滞20 min后测量患者感觉阻滞平面。两组患者全身麻醉方法相同,术毕两组患者均使用患者自控静脉镇痛(patient controlled intravenous analgesia,PCIA)。记录术后2、6、18、24、48 h静息和活动时VAS评分,记录患者PACU停留时间、术后PCIA按压次数、术后舒芬太尼用量、补救镇痛情况、副作用发生情况、住院时间及患者满意度。结果R组椎板阻滞20 min后测量锁骨中线处感觉阻滞节段为(5.7±0.9)个,R组患者术后2、6、18、24、48 h静息和活动时VAS明显低于G组(P<0.05);R组患者PACU停留时间、术后PCIA按压次数和术后舒芬太尼用量明显少于G组(P<0.05),其中R组2例(10%)患者、G组13例(65%)患者追加了曲马多补救镇痛,两组补救镇痛差异有统计学意义(P<0.05);R组患者术后满意度明显高于G组(P<0.05),两组患者术后恶心、呕吐发生率和住院时间差异无统计学意义(P>0.05)。结论超声引导下椎板阻滞可安全应用于胸腔镜下肺叶切除术,并能够提供良好的术后镇痛,患者满意度高。

Objective To observe the effects of ultrasound guided retrolaminar block on postoperative analgesia in patient un dergoing video assisted thoracoscopic lobectomy.Methods Forty patients scheduled for video assisted thoracoscopic lobectomy were divided into two groups according to the random number table method(n=20):a retrolaminar block combined with general anesthe sia group(group R)and a general anesthesia group(group G).Before general anesthesia,patients in group R underwent ultrasound guid ed retrolaminar block and could feel the blocked plane 20 min after blockage.Both groups adopted the same method for general anes thesia.Patients in the two groups received postoperative patient controlled intravenous analgesia(PCIA).The Visual Analogue Scale(VAS)scores at resting and during movement were recorded 2,6,18,24 h and 48 h after operation.The length of post anesthesia care unit(PACU)stay,the times of PCIA pressing,the doses of sufentanil after surgery,the needs for rescue analgesia,side effects,the length of hospitalization stay,and patient satisfaction were recorded.Results In group R,the number of sensory block segments at the midclavicular line was(5.7±0.9)20 min after retrolaminar block.The VAS scores at resting and during movement in group R were lower than those of group G 2,6,18,24,and 48 h after surgery(P<0.05).Group R presented remarkable decreases in the length of PA CU stay,the times of PCIA pressing and the doses of sufentanil after surgery,compared with group G(P<0.05).There were two patients in group R(10%)and thirteen patients in group G(65%)who needed rescue analgesia with tramadol,with statistical difference between the two groups(P<0.05).Patient satisfaction in group R was remarkably superior to that in group G(P<0.05).There was no significant difference in the incidence of nausea and vomiting and the length of hospitalization stay(P>0.05).Conclusions Ultrasound guided retrolaminar block is safe and effective for patients undergoing video assisted thoracoscopic lobectomy,and can provide good postopera tive analgesia,with good patient satisfaction.