竖脊肌平面阻滞与椎旁神经阻滞对肥胖患者腹腔镜袖状胃切除术后恢复质量影响的比较

Comparison of erector spinae plane block and paravertebral block on the quality of postoperative recovery in obese patients undergoing laparoscopic sleeve gastrectomy

目的探讨竖脊肌平面阻滞(ESPB)与椎旁神经阻滞(PVB)对腹腔镜袖状胃切除术肥胖患者术后恢复质量的影响。方法选择2021年1—3月择期腹腔镜袖状胃切除术的肥胖患者107例,男25例,女82例,年龄18~45岁,BMI 30~40 kg/m^(2),ASAⅡ或Ⅲ级。将患者随机分成两组:ESPB组(E组,n=54)和PVB组(P组,n=53)。E组于T_(8)行双侧ESPB,P组于T_(8)行双侧PVB,每侧均给予0.33%罗哌卡因20 ml。两组术中麻醉方案相同,术后行标准化镇痛。采用恢复质量15(QoR-15)量表评估术后24、48 h恢复质量。记录术后0.5、2、6、12、24、48 h静息和活动时NRS评分。记录术后48 h内镇痛药物用量、镇痛泵总按压次数和有效按压次数、补救镇痛例数、术后首次下床活动时间、术后首次肛门排气时间、术后住院时间、术后恶心呕吐(PONV)和神经阻滞相关并发症发生情况。结果两组术后24、48 h QoR-15评分、术后0.5、2、6、12、24、48 h静息和活动时NRS评分、术后48 h内镇痛药物用量、镇痛泵总按压次数和有效按压次数、补救镇痛率、术后首次下床活动时间、术后首次肛门排气时间、术后住院时间、PONV发生率差异均无统计学意义。两组无一例发生穿刺部位出血、血肿、气胸、神经损伤等神经阻滞相关并发症。结论竖脊肌平面阻滞对肥胖患者腹腔镜袖状胃切除术后恢复质量的作用与椎旁神经阻滞相似,两种神经阻滞方法均能取得良好的镇痛效果。

Objective To compare the effects of erector spinae plane block(ESPB)and paravertebral block(PVB)on the quality of recovery in obese patients undergoing laparoscopic sleeve gastrectomy.Methods A total of 107 obese patients undergoing laparoscopic sleeve gastrectomy from January to March 2021,25 males and 82 females,aged 18-45 years,BMI 30-40 kg/m^(2),ASA physical statusⅡorⅢ,were randomly divided into two groups:ESPB group(group E,n=54)and PVB group(group P,n=53).Nerve block was performed before induction of general anesthesia,bilateral ESPB was performed in group E and group P received bilateral PVB,the two groups was given 0.33%ropivacaine 20 ml per side.The two groups had the same intraoperative anesthesia scheme and standardized analgesia after operation.The 15-item quality of recovery questionnaire(QoR-15)was evaluated 24 and 48 hours after operation.Numeric rating scales(NRS)scores at rest and during exercise 0.5,2,6,12,24,48 hours after operation were recorded.The postoperative analgesic drug dosage within 48 hours,times of pressing and times of effective pressing of analgesic pump,the first time out of bed,the first intestinal exhaust time and hospital stay after operation were recorded.Postoperative nausea and vomiting(PONV)and nerve block related complications were recorded.Results There were no significant differences in QoR-15 scores 24 and 48 hours after operation,NRS score both at rest and during exercise 0.5,2,6,12,24,48 hours after operation,the postoperative analgesic drug dosage within 48 hours,the times of pressing and the times of effective pressing of analgesic pump,the rate of remedial analgesia within 48 hours after operation,the first time out of bed,the first intestinal exhaust time and hospital stay after operation,and incidence of PONV between the two groups.There was no patient had complications related to nerve block such as bleeding at the puncture site,hematoma,pneumothorax and nerve injury in the two groups.Conclusion The quality of recovery and analgesic effects in obese patients undergoing laparoscopic sleeve gastrectomy are similar between erector spinae plane block and paravertebral block.