超声引导菱形肌-肋间肌-低位前锯肌平面阻滞和胸椎旁神经阻滞对胸腔镜肺叶切除术后麻醉恢复质量的影响

Comparison of ultrasound-guided rhomboid intercostal and subserratus plane block versus thoracic paravertebral nerve block inthoracoscopic lobectomy

目的:比较超声引导菱形肌-肋间肌-低位前锯肌平面(RISS)阻滞和胸椎旁神经阻滞(TPVB)对胸腔镜肺叶切除术患者的影响。方法:将145例经胸腔镜肺叶切除术的患者随机分为RISS组(n=73)和TPVB组(n=72)。全麻诱导前,0.25%罗哌卡因患侧单次阻滞,RISS组用40 mL,TPVB组用20 mL,术毕均采用患者自控静脉镇痛(PCIA)。记录准备间时(T_(0))、切皮即刻(T_(1))、手术开始30 min(T_(2))和入PACU即刻(T_(pacu))的平均动脉压(MAP)、心率(HR),术中舒芬太尼和间羟胺追加量,术后24 h康复质量评分(QoR-15);术后1、6、12、24 h静息及深呼吸时VAS评分,PCIA首次时间、术后24 h有效按压次数、曲马多补救例数及原因,术后24 h不良反应和并发症。结果:RISS组术后24 h QoR-15评分[105.0(91.5~121.5)]低于TPVB组[120.5(106.3~129.0)](P<0.05)。两组术后1 d内VAS评分均数<4分。术后1、6和12 h,RISS组VAS评分高于同时点TPVB组(P<0.05)。与TPVB组相比,RISS组PCIA首次使用时间较早,术后24 h有效按压次数和曲马多补救例数增多,T2时点的HR亦增快,且术中舒芬太尼追加量增多,但间羟胺追加量减少(P<0.05)。结论:RISS阻滞和TPVB均能有效缓解胸腔镜肺叶切除术患者的术后疼痛,且TPVB的术后康复质量和镇痛效果优于RISS阻滞。

Objective:To compare the effect of ultrasound-guided rhomboid intercostal and subserratus plane(RISS)block with thoracic paravertebral nerve block(TPVB)on patients undergoing video-assisted thoracoscopic lobectomy.Methods:145 patients undergoing video-assisted thoracoscopic lobectomy were randomly divided into RISS group(n=73)and TPVB group(n=72).The single block on the affected side were performed before anesthesia induction in RISS group with 0.25%ropivacaine 40ml.And that were performed in TPVB group with 0.25%ropivacaine 20ml.The patient controlled intravenous analgesia(PCIA)was given to both groups postoperatively.The mean arterial pressure(MAP)and heart rate(HR)were recorded at preparation room admission(T_(0)),skin incision(T_(1)),30min after surgery(T_(2))and post anesthesia care unit(PACU)admission(T_(PACU)).The additional dosages of sufentanil and metaraminol were recorded during the operation.The quality of recovery-15 scale(QoR-15)score at 24 h,and visual analogue scale(VAS)score of pain at rest and deep breathing at 1 h,6 h,12 h,24 h after surgery were evaluated.The first time of PCIA,the frquency of effective pressing,the cases and reasons of remedial tramadol,adverse reactions and complications were recorded within 24 h after surgery.Results:The QoR-15 scores were(105.0,91.5~121.5)in RISS group at 24 h after surgery,which was significantly lower than(120.5,106.3~129.0)in TPVB group(P<0.05).All mean VAS scores of the two groups were less than 4 points within 1 d after surgery.At 1 h,6 h and 12 h after surgery,the VAS scores in RISS group were significantly higher than that in TPVB group at the same time(P<0.05).Compared with TPVB group,the first time of PCIA was significantly earlier,and the frquency of effective pressing and cases of remedial tramadol were significantly more in RISS group within 24 h after surgery(P<0.05).The HR at T2 were significantly higher in RISS group(P<0.05).The additional dosage of sufentanil was significantly more during the operation,and the dosage of metaraminol was significantly less in RISS group(P<0.05).Conclusion:Both RISS block and TPVB can effectively alleviate the postoperative pain of patients undergoing thoracoscopic lobectomy,and the postoperative rehabilitation quality and analgesic effect of TPVB are better than riss block.