菱形肌肋间肌-低位前锯肌平面阻滞与胸椎旁阻滞用于肺癌微创术后镇痛的效果比较

Comparison of Rhomboid Intercostal and Subserratus Plane Block and Parathoracic Block for Postoperative Analgesia after Thoracoscopic Radical Resection of Lung Cancer

目的:本研究旨在比较菱形肌肋间肌-低位前锯肌平面阻滞与胸椎旁阻滞用于肺癌微创术后镇痛的效果。方法:选择2019年1月至2021年4月在我院择期行胸腔镜手术患者60例,随机分为T组和R组。两组患者均采用支气管插管静脉全身麻醉,术后行PCIA,T组患者在麻醉诱导前行TPVB阻滞,R组行RISS阻滞。记录两组患者超声定位时间、穿刺时间、注药时间、阻滞关键操作总时间、穿刺针深度;记录术中丙泊酚、瑞芬太尼用量和血管活性药物使用情况;记录术后2、4、8、12、24、48h静止和咳嗽疼痛VAS评分;记录术后首次按压镇痛泵时间、48h内镇痛泵按压次数、氟比洛芬酯补救性镇痛例数、镇痛满意度评分;记录阻滞相关并发症和术后48h内恶心呕吐、眩晕发生情况。结果:与T组比较,R组患者超声定位时间、穿刺时间、操作总时间、穿刺针深度均明显降低(P<0.05),两组患者注药时间差异均无统计学意义(P>0.05);两组患者术后2h、4h、8h、12h、24h、48h静息和咳嗽疼痛VAS评分差异均无统计学意义(P>0.05);与T组比较,R组患者低血压发生率明显降低(P<0.05),间羟胺使用率明显降低(P<0.05),两组患者麻黄碱、阿托品、乌拉地尔、美托洛尔使用率差异均无统计学意义(P>0.05);两组患者术后首次按压PCA时间、术后48h内镇痛泵有效按压次数、氟比洛芬酯补救镇痛例数、镇痛满意度差异均无统计学意义(P>0.05);两组均未发生阻滞相关并发症;两组患者术后48h内恶心呕吐、眩晕发生率差异均无统计学意义(P>0.05)。结论:菱形肌-肋间肌-低位前锯肌平面阻滞与胸椎旁阻滞均能为胸腔镜肺癌根治术患者提供良好术后镇痛,两种方法镇痛效果及术后舒芬太尼使用情况相当。相比之下,前者操作时间更短,穿刺难度较低,术中低血压发生率及血管活性药物使用率较低,安全性更高。

Objective:To compare the analgesic effects of rhomboid intercostal and subserratus plane block and parathoracic block after thoracoscopic radical resection of lung cancer.Methods:From 2019 to 2021,60 patients were randomly divided into Group T and Group R.Patients in both groups were given general anesthesia through bronchial intubation,and PCIA was performed postoperatively.RISS block was performed in Group R before anesthesia induction,and TPVB block was performed in group T.The ultrasound positioning time,puncture time,injection time,total time of key block operation and puncture needle depth were recorded,and the dosage of propofol,remifentanil,the vasoactive drugs were recorded.The VAS scores of rest and cough pain at 2,4,8,12,24 and 48 hours after operation were recorded.The time of first pressing the analgesia pump,the times of pressing the analgesia pump within 48 hours,the number of cases of remedial analgesia with flurbiprofen axetil and the score of analgesia satisfaction were recorded.The occurrence of nausea,vomiting and dizziness within 48 hours after operation were recorded.The complications related to block between the two groups were recorded.Results:Compared with group T,ultrasound positioning time,puncture time,total operation time and puncture needle depth of Group R were significantly reduced(P<0.05),and there was no significant difference in injection time between the two groups(P>0.05).There was no significant difference in VAS scores of rest and cough pain at 2h,4h,8h,12h,24h,48h after operation between the two groups(P>0.05).Compared with group T,the incidence of hypotension in Group R was significantly lower(P<0.05),and the utilization rate of m-hydroxylamine was significantly lower(P<0.05).There was no significant difference in the utilization rate of ephedrine,atropine,urapidil and metoprolol between the two groups(P>0.05).There was no significant difference in the time of first pressing PCA after operation,effective pressing times of analgesia pump within 48 hours after operation,the number of rescue analgesia cases with flurbiprofen axetil,and analgesic satisfaction between the two groups(P>0.05).There was no significant difference in the incidence of nausea,vomiting and vertigo within 48h between the two groups(P>0.05).No block related complications occurred in both groups.Conclusion:Both rhomboid intercostal and subserratus plane block and thoracic paravertebral block can provide good postoperative analgesia for patients undergoing thoracoscopic radical resection of lung cancer.The analgesic effect and postoperative sufentanil use of the two methods are similar.In contrast,the former has shorter operation time,lower puncture difficulty,lower incidence of intraoperative hypotension and vasoactive drug use rate,and higher safety.