不同方式前锯肌阻滞在胸腔镜手术围术期镇痛中的应用

Application of different methods of serratus anterior block in perioperative analgesia of thoracoscopic surgery

目的比较超声引导下前锯肌阻滞(SAPB)与解剖定位下SAPB两种方式在胸腔镜手术围术期的镇痛效果。方法选取2019年9月~2020年12月择期行胸腔镜手术的40例患者作为研究对象,随机分为超声引导前锯肌阻滞组(US组)和解剖定位前锯肌阻滞组(AS组),每组各20例。US组于手术开始前15min在超声引导下前锯肌平面注射0.3%罗哌卡因30ml,AS组于手术开始前15min解剖位置前锯肌平面注射0.3%罗哌卡因30ml,患者术后均行纳布啡自控静脉镇痛。患者入室后标记时刻为T1,切皮即刻为T2,切皮后5min为T3,比较两组患者T1、T2、T33个时刻MAP、HR的变化。记录术后即刻、6h、24h、48h的NRS评分进行疼痛程度评估,记录术后6h、12h、24h、48h镇痛泵有效按压次数。结果两组患者年龄、性别、身高、BMI、手术时长等一般情况比较,差异均无统计学意义(P值均>0.05)。两组患者T1、T2、T33个时刻MAP、HR比较,差异均无统计学意义(P值均>0.05)。两组患者术后即刻、6h、24h、48h的NRS评分比较,差异均无统计学意义(P值>0.05)。术后6h、12h、24h、48h镇痛泵有效按压次数比较,差异无统计学意义(P>0.05)。结论超声引导下SAPB与解剖定位下SAPB在胸腔镜手术中均能减轻患者疼痛,安全可靠。与超声下SAPB相比,解剖定位下SAPB操作更简单,为基层胸科手术镇痛提供了新途径,可用于临床推广。

Objective To explore the comparison of perioperative analgesic effects of ultrasound-guided serratus anterior block(SAPB)and anatomical positioning of SAPB in the perioperative period of thoracoscopic surgery.Methods Select 40 patients in December 2019 to December 2019,as research objects,randomly divided into ultrasound-guided serratus anterior block(US group)and anatomical positioning serratus anterior block(AS group)20 cases each group.In the US group,30 ml of 0.3%ropivacaine was injected into the serratus anterior plane 15 minutes before the surgical skin incision.In the AS group,0.3%ropivacaine was injected into the anterior serratus plane 15 minutes before the surgical incision.Patient-controlled intravenous analgesia with nalbuphine was given after operation.After the patient entered the room,the marked time was T1,the skin incision was T2 immediately,and the skin incision was 5 min as T3.compared the changes of the two groups of patients T1,T2,T33 times MAP,compared the changes of the two groups of patients T1,T2,T33 times HR.The NRS score of postoperation immediately,6 h,24 h,48 h was evaluated,and the postoperative 6 h,12 h,24 h,and 48 h analgesic pump were valid.Results There were no statistically significant differences in general conditions such as age,gender,height,BMI,and length of operation between the two groups of patients(P>0.05).The MAP at T1,T2,T3 was no statistical difference at each time(P>0.05).The HR at T1,T2,T3 was no statistical differencein at each time(P value>0.05).There was no statistically significant difference in NRS score at 6 h,24 h and 48 h immediately after surgery between the two groups(P value>0.05).There was no statistically significant difference in effective pressure times of analgesia pump at 6 h,12 h,24 h and 48 h after surgery(P value>05).Conclusion Both ultrasound-guided serratus anterior block and anatomical positioning of the serratus anterior block can alleviate patient’s pain during thoracoscopic surgery,and safe and reliable.Compared with SAPB under ultrasound,SAPB under anatomical positioning is simple,and can provide a new way for the analgesia of primary thoracic surgery,and can be used for clinical promotion.