菱形肌-肋间肌-低位前锯肌平面阻滞在肺癌患者术后镇痛中的应用

Application of rhomboid intercostal and sub-serratus plane block for postoperative analgesia after lung cancer surgery

目的 探讨菱形肌-肋间肌-低位前锯肌(rhomboid intercostal and sub-serratus,RISS)平面阻滞在肺癌手术患者术后镇痛中的应用。方法 选择2020年1至9月择期行经胸腔镜肺癌根治术的患者40例,采用随机数字表法随机分为对照组(C组)和超声引导RISS平面阻滞组(R组),每组各20例。R组在全身麻醉诱导前行手术侧RISS平面阻滞,注射0.3%罗哌卡因30ml,C组不行外周神经阻滞。所有患者术后均予无线镇痛泵系统患者自控静脉镇痛(patient controlled intravenous analgesia,PCIA)。记录麻醉诱导前(T)、切皮后5min(T)及拔管后10min(T)的平均动脉压(mean arterial pressure,MAP)及心率(heart rate,HR),术后6、24、48h患者舒适度评分(Bruggrmann comfort scale,BCS),术后24h镇痛泵有效按压次数,补救性镇痛情况及不良事件的情况。结果 R组患者在T及T时的MAP和HR明显低于C组(P<0.05)。与T相比,C组患者在T及T时的MAP明显升高(P<0.05),HR明显升高(P<0.05)。R组患者术后6、24h BCS评分明显高于C组(P<0.05),两组患者术后48h评分比较,差异无统计学意义(P>0.05)。R组患者术后24h无线镇痛泵的有效按压次数及需要补救性镇痛的患者人数均显著少于C组(P<0.05)。两组患者均未发生气胸、局部麻醉药中毒、穿刺部位血肿等严重不良事件。结论 菱形肌-肋间肌-低位前锯肌平面阻滞可为肺癌手术患者提高完善的术后镇痛,安全性高。

Objective To investigate the application of rhomboid intercostal and sub-serratus plane block(RISS) for postoperative analgesia after lung cancer surgery. Methods Forty patients scheduled for thoracoscopic radical surgery of lung cancer between Janurary to September 2020 in Ningbo City Beilun District People’s Hospital were randomly divided into two groups: control group(group C), RISS group(group R), 20 patients in each group. Group R received 0.3% ropivacaine 30 ml preoperatively under ultrasound guidance RISS block at the surgical side. Group C did not receive peripheral nerve block. All patients received patient controlled intravenous analgesia(PCIA) with wireless analgesia pump system postoperatively. The mean arterial pressure(MAP) and heart rate(HR) were recorded before anesthesia induction(T), 5 min after skin incision(T) and 10 min after extubation(T). The score of Bruggrmann comfort scale(BCS) 6, 24 and 48 h after surgery, the number of analgesic pump compressions and number of patients requiring rescue analgesia, and the adverse effects were all recorded. Results Compared with group C, MAP and HR were significantly lower at Tand Tin group R(P<0.05). Compared with T, MAP at Tand Twere significantly higher in group C(P<0.05), HR at Tand Twere also significantly higher(P<0.05). The BCS score 6 h, 24 h after surgery was significantly higher in Group R than group C(P<0.05), but there was no difference at 48 h between the two groups(P>0.05). The number of analgesic pump compressions and number of patients requiring rescue analgesia was significantly lower in Group R than group C(P<0.05). There were no severe adverse events in both groups, such as pneumothorax, local anesthetic intoxication, hematoma at puncture site. Conclusion Ultrasound-guided rhomboid intercostal and sub-serratus plane block can provide effective analgesia in patients undergoing lung cancer surgery with high safety.