超声引导腹外斜肌平面阻滞用于上腹部手术患者术后镇痛的效果

Efficacy of ultrasound-guided external oblique plane block for postoperative analgesia after upper abdominal surgeries

目的评价超声引导下腹外斜肌平面阻滞用于上腹部手术患者术后镇痛的效果。方法择期上腹部手术患者120例,采用随机数字表法随机分为3组(n=40):对照组(C组)、低位前锯肌平面阻滞组(low anterior serratus plane block,SSPB)组及腹外斜肌平面阻滞(external oblique plane block,EOP)组。全身麻醉诱导后SSPB组超声引导双侧腋中线第8肋水平前锯肌平面阻滞,EOP组超声引导双侧锁骨中线第6肋水平腹外斜肌平面阻滞,注入0.25%罗哌卡因30 mL。3组均采用全身麻醉气管插管,术中静-吸复合麻醉维持,术毕行舒芬太尼自控镇痛(patient controlled intravenous analgesia,PCIA)。维持术后48 h内临床有效镇痛,视觉模拟评分法疼痛评分≥4分时按压PCIA泵,效果欠佳时静脉注射舒芬太尼0.1μg/kg,记录术中及术后48 h舒芬太尼用量、首次PCIA时间、PCIA按压次数及补救镇痛次数,记录术后48 h内恶心、呕吐等不良反应发生情况。记录神经阻滞操作时间。结果与C组比较,EOP组及SSPB组首次PCIA时间延长,术中舒芬太尼用量及术后48 h内舒芬太尼用量、补救镇痛次数及泵按压次数减少,不良反应发生率明显降低(P<0.05);EOP组神经阻滞操作时间短于SSPB组(P<0.05)。结论超声引导下腹外斜肌平面阻滞用于上腹部手术患者术后镇痛效果好,不良反应少。

Objective To evaluate the effect of ultrasound-guided external oblique plane block(EOP)on postoperative analgesia in patients undergoing upper abdominal surgery.Methods In total,120 patients receiving elective upper abdominal surgery were selected and divided into three groups(n=40):control group,low anterior serratus plane block(SSPB)group and EOP group according to random number table method.After induction of general anesthesia,SSPB group received ultrasound-guided anterior serratus plane block at the 8th rib level of bilateral axillary midline,and EOP group received ultrasound-guided EOP at the 6th rib level of bilateral clavicular midline,with 30 mL of 0.25%ropivacaine injected.The three groups were treated with general anesthesia,endotracheal intubation,intraoperative static inhalation combined anesthesia,and patient controlled intravenous analgesia(PCIA)with sufentanil after operation,to maintain the clinical effective analgesia within 48 h after operation.When the visual analogue scale(VAS)pain score was≥4,the PCIA pump was pressed.When the effect was poor,intravenous sufentanil 0.1μg/kg was injected.The dosage of sufentanil during operation and within 48 h after operation,the time to first PCIA,times of PCIA compression and times of remedial analgesia,and the occurrence of nausea,vomiting and other adverse reactions within 48 h after operation were recorded.The completion time of nerve block was recorded.Results Compared with control group,the time to first PCIA in EOP group and SSPB group was prolonged,the dosage of sufentanil during operation and within 48 h after operation,the times of remedial analgesia and pump compression were significantly reduced,and the incidence of adverse reactions was significantly reduced(P<0.05).The completion time of nerve block in EOP group was significantly shorter than that in SSPB group.Conclusion Ultrasound-guided EOP is effective in postoperative analgesia,with fewer adverse reactions in patients undergoing upper abdominal surgery.