超声引导下竖脊肌平面阻滞和椎旁神经阻滞对VATS患者术后镇痛和恢复影响的比较

Comparison of postoperative pain and recovery of erector spinae plane block and paravertebral block for patients undergoing video-assisted thoracoscopic surgery

目的比较超声引导下竖脊肌平面阻滞和椎旁神经阻滞对VATS患者术后镇痛和恢复的影响。方法纳入拟择期进行VATS的患者80例,年龄18~80岁,ASA分级Ⅰ~Ⅱ级,体重≥40kg。患者被随机分配到竖脊肌平面阻滞组(ESPB组,n=40)和椎旁神经阻滞组(PVB组,n=40),分别使用30、20mL 0.375%罗哌卡因进行阻滞。主要观察指标是术后第1天的40项恢复量表(QoR-40)评分,次要观察指标是术后1、6和12h的NRS疼痛评分。同时记录患者术中舒芬太尼的使用量、术后并发症的发生情况以及患者满意度。结果 ESPB组和PVB组术后第1天的QoR-40量表评分(P=0.829)及术后1、6和12h的NRS疼痛评分差异均无统计学意义(P=0.0655、P=0.423、P=0.426)。两组患者术中舒芬太尼的使用量和术后并发症的发生情况也均无明显差异。ESPB组的患者满意度更高(P=0.0033)。结论超声引导下竖脊肌平面阻滞在加快VATS患者康复和术后镇痛方面与椎旁神经阻滞效果相当。竖脊肌平面阻滞可以作为一种新型的区域神经阻滞技术广泛应用于临床。

Objective To compare postoperative outcomes of erector spinae plane block(ESPB) and paravertebral block(PVB) in patients undergoing video-assisted thoracoscopic surgery(VATS). Methods Eighty ASA Ⅰ-Ⅱ patients, aged 18-80 years and weighted >40 kg, scheduled for elective VATS were enrolled in this study. Patients were randomly assigned into two groups with 40 cases in each group: ESPB group received ultrasound-guided erector spinae plane block with 30 mL of 0.375% ropivacaine and PVB group received ultrasound-guided paravertebral block with 20 mL of 0.375% ropivacaine. The primary outcome was evaluated with Quality of Recovery-40(QoR-40) score on postoperative day 1(POD1). The secondary outcome was NRS pain score during the first 12 hours. Other outcomes included intraoperative sufentanil consumption, postoperative complications and patient satisfaction. Results No significant differences were found in these two groups for global QoR-40 scores on POD1(P=0.829), or the NRS pain scores at postoperative 1, 6 and 12 h(P=0.0655, P=0.423 and P=0.426, respectively), as well as intraoperative sufentanil consumption and postoperative complications. Patient satisfaction was better in ESPB group compared to PVB group(8.3±1.3 vs 7.4 ±1.4, P=0.0033). Conclusion This study showed that ultrasound-guided ESPB is an effective regional block technique comparable to PVB in improving rapid recovery and reducing postoperative pain for patients undergoing VATS, indicating that ESPB may serve as a substitute of PVB for rapid recovery and postoperative pain control.