超声引导下单次前锯肌平面阻滞对胸腔镜患者术后镇痛效应及炎性反应的影响

Effect of single ultrasound-guided serratus plane block on postoperative analgesia and inflammatory response in patients undergoing video-assisted thoracoscopy

目的观察超声引导下单次前锯肌平面阻滞(SPB)对胸腔镜手术术后镇痛及炎性反应的影响。方法择期胸腔镜手术患者80例,ASAⅠ或Ⅱ级,年龄27~64岁。采用随机数字表法分为两组:全身麻醉复合前锯肌平面阻滞组(SP组,n=40)和单纯全身麻醉组(CON组)。SP组术前30 min行超声引导下术侧前锯肌平面阻滞,注入0.5%盐酸罗哌卡因20 ml,所有患者术后均行患者自控静脉镇痛(patient-controued intravenous analgesia,PCIA)。记录两组患者PACU苏醒期间镇静Ramsay评分及视觉模拟疼痛评分(visual analogue score,VAS)评分,记录两组患者术后2、6、12、24、48 h静息状态及咳嗽时VAS,术后24 h镇痛补救情况;观察术后有无前锯肌平面阻滞并发症及不良反应情况。分别于麻醉诱导前即刻、术后1、3 d抽取患者静脉血,采用ELISA法检测血清IL-6、IL-10的浓度。结果SP组患者在超声引导下顺利完成前锯肌平面阻滞,未见由穿刺引起的相关并发症。两组患者PACU苏醒期间镇静Ramsay评分及VAS评分无显著性差异。与CON组比较,SP组术后12 h内静息状态、咳嗽时的VAS评分均显著降低(P<0.05),术后舒芬太尼用量明显减少(P<0.05)。两组患者术后恶心、呕吐等不良反应发生情况无显著性差异。与诱导前比较,术后1天两组患者血清IL-6、IL-10浓度均明显升高,与CON组比较,术后1天SP组IL-6浓度明显降低(P<0.05)、IL-10浓度明显升高(P<0.05)。结论超声引导下单次SP能有效减轻胸腔镜手术患者术后早期(12 h)急性疼痛,减少术后静脉镇痛药的需要量,减轻患者炎性反应。

Objective To investigate the effect of single ultrasound-guided serratus plane block(SPB)on postoperative analgesia and inflammatory response in patients undergoing video-assisted thoracoscopy.Methods Eighty patients(ASAⅠorⅡ),aged between 27 to 64 years old and scheduled for elective video-assisted thoracoscopy operation,were randomized into two groups(n=40 each):SPB+general anesthesia group(group SP)and simple general anesthesia group(group CON).Patients in group SP received SPB by ultrasound-guided injection of 0.5%ropivocaine at 30 min before the surgery.The both groups received patient-controlled intravenous analgesia(PCIA)after operation.Ramsay sedation score and visual analogue score(VAS)were recorded immediately after awakening in postanesthesia care unit(PACU).The two groups were also recorded for VAS at rest and during coughing at 2,6,12,24 and 48 h after operation,salvage use of analgesics(sufentanil)within 24 h after operation,as well as complications or adverse reactions related to SPB.Phlebotomy to collect serum samples for measurement of IL-6 and IL-10 was performed for all patients immediately prior to anesthesia induction,and at 1,3 days after operation.Results There was no significant difference in Ramsay sedation score and VAS after awakening at PACU between the two groups.Compared with group CON,the group SP showed significantly lower VAS at rest and during coughing(P<0.05)and less sufentanil use within 12 h after operation(P<0.05).There was no significant difference in adverse reaction such as nausea and vomiting between the two groups.Compared with before induction,the IL-6 and IL-10 levels were significantly elevated in both groups at 1 day after operation,Compared with group CON,the group SP showed significantly lower IL-6 level(P<0.05)and higher IL-10 level(P<0.05)at 1 day after operation.Conclusion Single use of ultrasound-guided serratus plane block during video-assisted thoracoscopy may effectively relieve pain early after operation(within 12 h),reduce the postoperative use of intravenous analgesics,and ameliorate inflammatory response in the patients.