竖脊肌平面阻滞在后腹腔镜肾切除术中的应用:前瞻性随机双盲对照研究

Application of Erector Spinae Plane Block in Retroperitoneal Laparoscopic Nephrectomy:Prospective Randomized Double-blind Controlled Study

目的探讨超声引导下竖脊肌平面阻滞在后腹腔镜肾切除术围术期镇痛的应用价值。方法选择2019年9月~2021年11月择期全麻后腹腔镜肾切除术60例,随机分为联合竖脊肌平面阻滞组(E组)和对照组(C组),每组30例。E组在麻醉诱导前行超声引导下竖脊肌平面阻滞,于T_(10)横突注射0.33%罗哌卡因30 ml,C组注射生理盐水30 ml。2组全麻方法相同。2组术毕均给予静脉患者自控镇痛(patient-controlled intravenous analgesia,PCIA)。记录麻醉药用量、拔管时间、麻醉恢复室(postanesthesia care unit,PACU)停留时间。记录术后即刻、1、6、12、24和48 h疼痛视觉模拟评分(Visual Analogue Scale,VAS)、PCIA泵有效按压次数、补救镇痛药物用量、不良反应发生率。结果与C组比较,E组瑞芬太尼和帕瑞昔布用量明显减少[(1353.4±117.5)μg vs.(1514.6±179.1)μg,t=-4.121,P=0.000;(25.3±30.6)mg vs.(73.3±23.7)mg,t=-6.795,P=0.000],术后拔管时间和PACU停留时间均明显缩短[(11.7±2.2)min vs.(17.5±1.9)min,t=-10.738,P=0.000;(21.9±2.1)min vs.(26.9±2.8)min,t=-7.996,P=0.000],术后48 h镇痛泵有效按压次数明显减少[(17.4±2.2)次vs.(26.0±1.6)次,t=-17.701,P=0.000],术后1、6、12和24 h静息和活动VAS评分均较低,且术后不良反应明显减少(P<0.05)。结论超声引导下竖脊肌平面阻滞在后腹腔镜肾切除术的围术期可提供充分的镇痛。

Objective To investigate the value of ultrasound-guided erector spinae plane block in perioperative analgesia after retroperitoneal laparoscopic nephrectomy.Methods A total of 60 cases of retroperitoneal laparoscopic nephrectomy after general anesthesia from September 2019 to November 2021 were randomly divided into combined erector spinae plane block group(Group E)and control group(Group C),with 30 cases in each group.In the Group E,30 ml of 0.33%ropivacaine was injected into the transverse process of T_(10),and in the Group C,30 ml of normal saline was injected similarly.The methods of general anesthesia were the same in the two groups.Both groups were given patient-controlled intravenous analgesia(PCIA)after operation.The dosage of anesthetics,extubation time and stay time in postanesthesia care unit(PACU)were recorded.The Visual Analogue Scale(VAS),times of effective compression of PCIA pump,amount of remedial analgesic drugs and incidence of adverse reactions were recorded immediately,1,6,12,24 and 48 hours after operation,respectively.Results Compared with the Group C,the dosage of remifentanil and parecoxib in the Group E decreased significantly[(1353.4±117.5)μg vs.(1514.6±179.1)μg,t=-4.121,P=0.000;(25.3±30.6)mg vs.(73.3±23.7)mg,t=-6.795,P=0.000],the extubation time and PACU residence time after operation were significantly shortened[(11.7±2.2)min vs.(17.5±1.9)min,t=-10.738,P=0.000;(21.9±2.1)min vs.(26.9±2.8)min,t=-7.996,P=0.000],and the effective pressing times of analgesic pump at 48 hours after operation were significantly reduced[(17.4±2.2)times vs.(26.0±1.6)times,t=-17.701,P=0.000].The VAS scores of rest and activity in the Group E were lower at 1,6,12 and 24 hours after operation,and the postoperative adverse reactions were significantly reduced(P<0.05).Conclusion Ultrasound-guided erector spinae plane block can provide sufficient analgesia in the perioperative period of retroperitoneal laparoscopic nephrectomy.