术前竖脊肌平面阻滞应用在机器人辅助肾部分切除术的镇痛效果评价

Analgesic Efficacy of Pre-emptive Ultrasound-guided Erector Spinae Plane Block in Robot-assisted Partial Nephrectomy

【目的】评价术前竖脊肌平面阻滞(ESPB)应用在机器人辅助肾部分切除(RAPN)术的镇痛效果。【方法】选择接受择期肾部分切除手术的成年患者共100例,随机分为竖脊肌平面阻滞(E组)和胸椎旁神经阻滞组(T组),每组50例。神经阻滞的实施均为超声引导辅助,由熟练的麻醉医生进行操作。神经阻滞局麻药物均采用0.5%罗哌卡因溶液,术后结合应用患者自控静脉镇痛。记录穿刺后成像时间,穿刺使用时间,总穿刺次数,穿刺难度评分,术中泵注瑞芬太尼与丙泊酚的总量,术后24 h内静息和运动视觉模拟评分(VAS),患者自控静脉镇痛泵按压次数,以及穿刺并发症的发生率和满意度。【结果】与T组比较,E组患者神经阻滞成像时间、穿刺使用时间显著缩短,穿刺次数更少,穿刺难度评分也显著降低(P<0.001)。其余观察指标两组间均无统计学差异(P>0.05)。【结论】术前ESPB应用在RAPN围手术期镇痛效果和胸椎旁神经阻滞效果相当,但是ESPB所需操作时间较短,穿刺次数少,难度较低,可能易于初学者掌握。

【Objective】To evaluate the analgesic efficacy of erector spinae plane block(ESPB)in patients undergoing robot-assisted partial nephrectomy(RAPN).【Methods】One hundred patients scheduled for RAPN were randomized into ESPB group(Group E)and thoracic paravertebral block(TPVB)group(Group T),with 50 cases in each group.Ultrasound-guided nerve block was performed by senior experienced anesthesiologists in both groups.All patients received 0.5%ropivacaine hydrochloride and postoperative patient controlled intravenous analgesia(PCIA).The imaging time,needling time,number of needle passes,difficulty scale,consumption of remifentanil and propofol,pain visual analog scale(VAS)scores at rest and movement within 24 hours after surgery,pressing frequency of PCIA pump,postoperative complications and patients′satisfaction with analgesic efficacy were assessed and recorded.【Results】Compared with TPVB,ESPB required significantly shorter imaging time and needling time,significantly fewer number of needle passes and lower difficulty scale(P<0.001).No significant difference was observed in term of the rest parameters between two groups(P>0.05).【Conclusion】Pre-emptive ultrasound-guided ESPB results in similar analgesic efficacy with TPVB in patients undergoing RAPN.ESPB may be easier for the junior doctors to perform due to its apparent superiority.