超声引导下前锯肌平面阻滞用于微创心血管外科手术的研究进展

Research progress of ultrasound-guided serratus anterior plane block in minimally invasive cardiovascular surgery

与传统开胸手术比较,微创心血管外科手术具有手术切口小、阿片类药物用量少、术后拔管早、恢复快等优点,但术后疼痛仍较为明显。随着可视化技术及快速康复外科理念普及,区域阻滞技术成功率和安全性大大提高,阻滞范围也逐渐由中枢性阻滞转移至周围神经阻滞,使其在微创心血管外科手术中的应用也越来越广泛。前锯肌平面阻滞(SAPB)是一种安全有效的筋膜平面阻滞技术,通过超声引导使局麻药在前锯肌间隙扩散,有效阻滞肋间神经外侧皮支,浸润胸长神经及胸背神经,为前外侧胸壁提供术中和术后镇痛。本文就超声引导下SAPB在不同类型微创心血管外科手术中应用的现状、优势及不足进行综述,为其临床应用提供参考。

Compared with traditional thoracotomy,minimally invasive cardiovascular surgery has smaller incision,less use of opioids,early postoperative extubation and quick recovery,but the postoperative pain is still obvious.With the popularization of visualization technology and the concept of enhanced recovery after surgery,the success rate and safety of regional anesthesia are greatly improved,and the block range is gradually transferred from neuraxial block to peripheral nerve block,which makes its application in minimally invasive cardiovascular surgery more and more extensive.Serratus anterior plane block is a safe and effective fascia plane block technique.Through ultrasound guidance,local anesthetics can diffuse in the anterior serratus space,effectively block the lateral cutaneous branch of intercostal nerve,infiltrate the long thoracic nerve and dorsal thoracic nerve,and provide intraoperative and postoperative analgesia for the anterolateral chest wall.This paper reviews the current status,advantages and disadvantages of ultrasound-guided SAPB in different types of minimally invasive cardiovascular surgery,so as to provide reference for its clinical application.