竖脊肌平面阻滞与胸椎旁神经阻滞用于胸腔镜肺叶切 除术患者术后镇痛比较:一项随机、双盲、前瞻性研究

Postoperative analgesia in thoracoscopic lobectomy patients using erector spinae plane block versus thoracic paravertebral block:A randomized,double-blind,prospective study

目的比较超声引导竖脊肌平面阻滞(ESPB)和胸椎旁神经阻滞(TPVB)用于胸腔镜肺叶切除术(VATS)患者术后镇痛的效果。方法收集择期行双孔VATS的患者90例,采用随机数字表法分为ESPB组和TPVB组。ESPB组在胸5横突与竖脊肌之间注入0.5%罗哌卡因20 ml,TPVB组在胸5胸椎旁间隙注入0.5%罗哌卡因20 ml。两组患者均使用舒芬太尼进行术后自控镇痛。观察记录术后2 h、6 h、8 h、12 h、24 h、48 h静息和咳嗽时疼痛视觉模拟评分(VAS)、术后恶心呕吐(PONV)发生的例数、麻醉后复苏室(PACU)停留时间、首次下床活动时间、引流管拔除时间、术后住院时间、术后舒芬太尼用量及补救镇痛例数等。结果两组患者术后2 h、6 h、8 h、12 h、24 h、48 h静息和咳嗽时VAS、24 h及48 h舒芬太尼用量比较,差异均无统计学意义(t分别=0.53、-0.12、1.56、0.41、0.18、1.59、-0.89、-0.87、0.23、-0.97、-0.90、-1.34、1.13、1.05,P均>0.05);PACU停留时间、首次下床活动时间、引流管拔除时间、术后住院时间、48 h内PONV发生率和补救镇痛例数比较,差异均无统计学意义(t分别=-1.16、-1.30、0.68、1.34,χ^(2)分别=1.64、0.31,P均>0.05)。结论超声引导单次ESPB为VATS提供可靠的术后镇痛,与TPVB相比有相似镇痛效果,但操作更简单安全易行。

Objective To compare the efficacy of ultrasound-guided erector spinae plane block and thoracic paraverte⁃bral block for postoperative analgesia in patients with thoracoscopic lobectomy.Methods A total of 90 patients who un⁃derwent double-port thoracoscopic lobectomy were randomly divided into erector spinae plane block(ESPB)group and thoracic paravertebral block(TPVB)group.In the ESPB group,0.5%ropivacaine 20ml was injected between the trans⁃verse process of T5 and the erector spinae muscle,and in the TPVB group,0.5%ropivacaine 20ml was injected into the thoracic paravertebral space of T5.Both groups received sufentanil for postoperative controlled analgesia.Visual analogue score(VAS)in resting and coughing at 2h,6h,8h,12h,24h,48h,the number of postoperative nausea and vomiting(PONV),postanesthesia care unit(PACU)stay time,first ambulation time,drainage tube removal time,postoperative hos⁃pital length of stay,postoperative sufentanil dosage and rescue analgesic cases were recorded.Results There was no sig⁃nificant difference in VAS in resting and coughing at 2h,6h,8h,12h,24h,48h and sufentanil dosage in 24h and 48h be⁃tween two groups after surgery(t=0.53,-0.12,1.56,0.41,0.18,1.59,-0.89,-0.87,0.23,-0.97,-0.90,-1.34,1.13,1.05,P>0.05).There was no significant difference in PACU duration,first ambulation time,drainage tube removal time,postop⁃erative length of stay,incidence of PONV and rescue analgesic cases(t=-1.16,-1.30,0.68,1.34,χ^(2)=1.64,0.31,P>0.05).Conclusion Ultrason-guided ESPB provided reliable postoperative analgesia and have similar analgesic effects compared to TPVB,but it was simpler,safer and easier to operate.