椎板后阻滞和竖脊肌平面阻滞在多发肋骨骨折手术患者术中及术后镇痛效果的比较

Comparsion of postoperative and intraoperative analgesic effect between retrolaminar block and erector spinae plane block in patients undergoing multiple rib fractures

目的探讨超声引导下椎板后阻滞(RLB)和竖脊肌平面阻滞(ESPB)对多发肋骨骨折患者术中和术后镇痛效果的影响。方法选择行肋骨骨折内固定手术患者80例,男57例,女23例,年龄25~65岁,ASAⅠ或Ⅱ级。随机分为两组:RLB组和ESPB组,每组40例。两组在全身麻醉后实施超声引导下RLB和ESPB,均给予0.5%罗哌卡因0.4 ml/kg。术后两组均行静脉自控镇痛(PCIA)。记录术中瑞芬太尼用量。记录术前静息以及术后2、4、12、24、48 h静息和咳嗽时VAS疼痛评分。记录PACU滞留时间、PCIA有效按压次数、补救镇痛例数、穿刺相关并发症及不良反应的发生情况。结果与EAPB组比较,RLB组术中瑞芬太尼用量明显减少(P<0.05),术后2、4、12、24 h静息和咳嗽时VAS疼痛评分明显降低(P<0.05),PACU滞留时间明显缩短(P<0.05),PCIA有效按压次数明显减少(P<0.05),补救镇痛率、恶心呕吐发生率明显降低(P<0.05)。结论与ESPB比较,全身麻醉联合超声引导下RLB可以有效减少多发肋骨骨折患者术中阿片类药物的用量,减轻术后疼痛。

Objective To compare the effect of ultrasound-guided retrolaminar block(RLB)and erector spinal plane block(ESPB)on intraoperative and postoperative analgesia in patients with multiple rib fractures.Methods Eighty patients with multiple rib fracture scheduled for internal fixation of rib fractures,57 males and 23 females,aged 25-65 years,ASA physical statusⅠorⅡ,were randomly divided into two groups:RLB group(n=40)and ESPB group(n=40).Patients in the two groups were adminstrated 0.5%ropivacaine 0.4 ml/kg in lateral decubitus position after general anesthesia.Patients in both groups were given patient-controlled intravenous analgesia(PCIA)after operation.The intraoperative dosage of remifentanil,VAS pain score for rest at preoperative,VAS pain score at rest and coughing 2,4,12,24,and 48 hours after operation,PCIA effective pressing times,PACU retention time,rescue analgesia rate,puncture related complications and adverse reactions were recorded.Results The dosage of remifentanil during operation,VAS pain scores at rest and coughing 2,4,12 and 24 hours after operation in RLB group were significantly lower than those in ESPB group(P<0.05).The retention time of PACU,the effective pressing times of PCIA,rescue analgesia rate and incidence of nausea and vomiting in RLB group were significantly less than those in ESPB group(P<0.05).Conclusion General anesthesia combined with ultrasound-guided RLB can effectively reduce the intraoperative opioid dosage and postoperative pain in patients with multiple rib fractures,and the effect is better than that of ESPB.