舒芬太尼联合罗哌卡因在超声引导下行ESPB对VATS患者的镇痛效果评价

Evaluation of analgesic effect of sufentanil combined with ropivacaine in ultrasound-guided ESPB in patients undergoing VATS

目的探讨舒芬太尼联合罗哌卡因在超声引导下行竖脊肌平面阻滞对电视辅助胸腔镜术(VATS)患者的镇痛效果。方法选择2018年2月至2019年2月在成都市第二人民医院行VATS患者60例,分为试验组(舒芬太尼联合罗哌卡因,SL组)和对照组(单用罗哌卡因,LP组)。两组患者全身麻醉后均在超声引导下行第5胸椎(T5)横突竖脊肌平面阻滞(ESPB),SL组给予0.1μg/kg舒芬太尼联合0.4%罗哌卡因共25 mL,LP组给予0.4%罗哌卡因25 mL,术毕两组均使用静脉镇痛泵,镇痛泵药物配方为舒芬太尼50μg+布托菲诺7 mg+托烷司琼10 mg+生理盐水稀释到100 mL。背景剂量2 mL,单次按压剂量1 mL,锁定时间20 min。记录术后1、6、12、24、36、48 h静息和咳嗽时的视觉模拟(VAS)评分、镇痛泵按压次数、手术时间、出血量、住院时间及术后不良反应的发生。结果SL组患者术后24、36、48 h静息和咳嗽VAS评分均明显低于LP组(P<0.05),SL组患者术后48 h镇痛泵按压次数显著减少(P<0.05),两组患者术后恶心、呕吐、瘙痒发生率无明显差异(P>0.05)。SL组住院时间较LP组明显缩短(P<0.05)。结论舒芬太尼联合罗哌卡因在超声引导下行ESPB对VATS患者术后疼痛控制的效果更好,镇痛时间更长,住院时间更短,更符合快速康复的理念。

Objective To investigate the analgesic effect of sufentanil combined with ropivacaine in ultrasound-guided erector spine plane block(ESPB)in the patients undergoing video-assisted thoracoscopic surgery(VATS).Methods Sixty patients undergoing VATS in Chengdu Municipal Second People′s Hospital from February 2018 to February 2019 were selected and divided into the experimental group(sufentanil combined with ropivacaine,SL group)and control group(simple ropivacaine,LP group).After general anesthesia,the two groups conducted the ultrasound-guided T5 transverse process ESPB.The SL group was given 0.1μg/kg sufentanil combined with 0.4%ropivacaine for 25 mL,and the LP group was given 0.4%ropivacaine for 25 mLThe two groups all used the patient-controlled intravenous analgesia(PCIA)after operation,the analgesic pump drug formula was sufentanil 50 ntanibutofino 7 mg+tropisetron 10 mg+normal saline,which was diluted to 100 mL.The background dose was 2 mL,the once press dose was 1 mL,the locking time was 20 min.The VAS score of resting and coughing at postoperative 1,6,12,24,36,48 h,number of analgesic pump compressions,surgery time,bleeding amount,length of hospital stay and occurrence of postoperative adverse reactions were recorded.Results The VAS scores of resting and coughing at postoperative 24,36,48 h in the SL group were significantly lower than those in the LP group(P<0.05).The compression times of analgesicpump at postoperative 48 h in the SL group were significantly decreased(P<0.05).There was no statistically significant difference in the incidence rates of postoperative nausea,vomiting and itching between the two groups(P>0.05).The length of hospital stay in the SL group was significantly shorter than that in the LP group(P<0.05).Conclusion Sufentanil combined with ropivacaine for conducting ESPB under ultrasound guide in the patients with VATS has better analgesic effect,longer analgesic time,shorter hospitalization time and is more in line with the rapid recovery idea.the rapid recovery idea.