超声引导下椎旁神经阻滞与竖脊肌平面阻滞用于胸腔镜肺叶切除术的镇痛效果比较

Comparison on analgesic effects of ultrasound-guided thoracic paravertebral block versus erector spinae plane block in thoracoscopic lobectomy

目的比较胸腔镜肺叶切除术中超声引导下椎旁神经阻滞(TPVB)与超声引导下竖脊肌平面阻滞(ESP)的镇痛效果。方法抽取2019年1月至2021年12月于长垣市人民医院接受胸腔镜肺叶切除术治疗的80例患者为研究对象, 术后均采取患者自控镇痛(PCIA), 并根据镇痛方式分为观察组和对照组, 每组40例。观察组予以超声引导下ESP方案, 对照组予以超声引导下TPVB方案。比较两组镇痛效果。结果观察组神经阻滞操作时间[(3.85±1.92)min]短于对照组[(5.15±2.12)min], 穿刺深度[(4.33±1.15)cm]小于对照组[(7.60±1.25)cm], P<0.05;静息状态或咳嗽状态下, 两组术后1、6、12 h时的视觉模拟评分法(VAS)评分比较差异未见统计学意义(P>0.05), 但术后18、24 h时, 观察组VAS评分均低于对照组(P均<0.05)。两组PCIA时首次按压时间、按压有效次数及镇痛泵输注总量比较差异未见统计学意义(P>0.05);两组不良反应发生率比较差异未见统计学意义(P>0.05)。结论超声引导下ESP与TPVB两种麻醉方案应用于胸腔镜肺叶切除中效果相似, 但ESP方案可缩短神经阻滞操作时间, 穿刺深度更浅, 且能更好地缓解术后疼痛程度, 安全性好。

Objective To compare the analgesic effect of ultrasound-guided thoracic paravertebal block(TPVB)and ultrasound-guided erector spinae plane block(ESP)in thoracoscopic lobectomy.Methods Eighty patients who underwent thoracoscopic lobectomy treated in Changyuan People’s Hospital from January 2019 to December 2021 were selected as the research objects,and all of them used patient-controlled analgesia(PCIA)after operation.Patients were divided into observation group and control group according to the analgesia methods,with 40 cases in each group.The observation group was given the ultrasound-guided ESP regimen,and the control group was given the ultrasound-guided TPVB regimen.The analgesic effects of the two groups were compared.Results The operation time of nerve block in the observation group was(3.85±1.92)min,shorter than the(5.15±2.12)min in the control group(P<0.05);and the puncture depth of the observation group was(4.33±1.15)cm,less than the(7.60±1.25)cm of the control group(P<0.05).There was no significant difference in visual analogue scale(VAS)scores in the resting state or coughing state between the two groups 1,6 and 12 hours after operation(P>0.05);however,the VAS scores of the observation group were lower than those of the control group 18 and 24 hours after operation(all P<0.05).There was no significant difference in the first press time,effective press times and total amount of analgesic pump infusion during PCIA between the two groups(P>0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions Ultrasound-guided ESP and TPVB have similar effects in thoracoscopic lobectomy,but ESP can shorten the operation time of nerve block,shallower puncture depth,and better relieve postoperative pain,with good safety.