竖脊肌平面阻滞对VATS患者术后镇痛的影响

Evaluate the effectiveness of erector spinae plane block for analgesia in patients undergoing video-assisted thoracoscopic surgery

目的:本研究旨在评估竖脊肌平面阻滞对VATS患者术后镇痛及术中阿片类药物使用量的影响。方法:纳入拟择期进行VATS手术的患者91例,随机分为竖脊肌平面阻滞组(ESPB组,45例)和对照组(46例)。ESPB组患者在术前采用0.31%的罗哌卡因30 ml进行竖脊肌平面阻滞,对照组患者不进行任何操作。记录患者术后24 h内的NRS疼痛评分、术中舒芬太尼的使用量、术后第1天的40项恢复量表(QoR-40)评分以及术后并发症的发生情况。结果:与对照组相比,ESPB组患者术后1 h、6 h、12 h和24 h的NRS疼痛评分明显降低:ESPB组患者术中舒芬太尼的总使用量以及每小时每千克体重舒芬太尼使用量均明显低于对照组[(104.6±23.4)μg vs.(122.3±28.9)μg],差异有统计学意义(P=0.0032、P<0.0001);[(0.82±0.17)μg/(kg·h)vs.(1.30±0.33)μg/(kg·h)]。另外,ESPB组术后第一天的QoR-40评分明显高于对照组[186(180.5~188.5)vs.181(171~186)],差异有统计学意义(P=0.0015)。两组患者术后不良反应和并发症无明显差异。结论:对于VATS患者,术前采用竖脊肌平面阻滞可减轻患者术后疼痛和术中阿片类药物使用量。

Objective The aim of this study was to evaluate the effectiveness of erector spinae plane block on postoperative analgesia and intra-operative opioid consumption in VATS patients.Method 91 patients were randomly allocated into erector spinae plane block group with 30 ml ropivacaine 0.31%(n=45),or no block without placebo or sham group(n=46).The postoperative NRS pain score and intra-operative sufentanil consumption were analyzed.Postoperative QoR-40 scores and postoperative complications were also recorded.Results Erector spinae plane block reduced the median(IQR)pain scores during postoperative 1 h,6 h,12 h and 24 h:respectively.Erector spinae plane block also reduced the mean(SD)intra-operative total sufentanil consumption and per hour,per kilogram sufentanil consumption(104.6±23.4)vs.(122.3±28.9)μg,P=0.0032;(0.82±0.17)μg/(kg·h)vs.(1.30±0.33)μg/(kg·h),P<0.0001,as well as increased the median(IQR)global QoR-40 scores on POD1[186(180.5-188.5)vs.181(171-186),P=0.0015].Conclusion Erector spinae plane block can be used to reduce postoperative pain and intra-operative opioid consumption for thoracoscopic lung surgery patients.