高位胸椎竖脊肌平面阻滞与臂丛上干阻滞在全身麻醉肩关节镜手术中应用的比较

Comparison of High Thoracic Erector Spinae Plane Block and Superior Trunk Block in Patients Undergoing General Anesthesia for Shoulder Arthroscopy

目的比较高位胸椎竖脊肌平面阻滞(high thoracic erector spinae plane block,HT-ESPB)与臂丛上干阻滞(superior trunk block,STB)在肩关节镜手术围手术期的镇痛效果。方法纳入择期全身麻醉下行肩关节镜肩袖修补术病人共计60例,采用随机数字法将其分为HT-ESPB组(30例)与STB组(30例)。记录两组术中镇痛药物用量、拔管时间、膈肌阻滞发生率、相关并发症;术后2、6、12、24、48、72 h时静息和活动时的疼痛视觉模拟量表(VAS)评分,术后曲马多镇痛补救情况,病人术后镇痛满意度评分,术后24、48、72 h的15项恢复质量量表(QoR-15)评分以及不良反应发生情况。结果HT-ESPB组术中舒芬太尼用量高于STB组[(21.5±11.1)μg vs.(15.6±10.3)μg,P=0.037],术后曲马多用量高于STB组[(36.9±10.2)mg vs.(25.4±9.5)mg,P<0.001],膈神经阻滞发生率低于STB组(0 vs.80%,P<0.001),术后24 h QoR-15评分显著高于STB组[(76.3±12.2)分vs.(66.4±11.6)分,P=0.003];两组病人静息和活动时VAS评分、镇痛满意度评分、并发症发生率差异无统计学意义(P>0.05)。结论肩关节镜手术中应用HT-ESPB能达到与STB类似的麻醉和镇痛效果,且膈神经阻滞发生率更低,尽管其镇痛药补救需求更多,仍是STB一种可行的替代方案。

Objective To compare the perioperative effects of high thoracic erector spinae plane block(HT⁃ESPB)and superior trunk block(STB)in patients undergoing shoulder arthroscopy.Methods A total of 60 patients scheduled for shoulder arthroscopy under general anesthesia were selected.All patients were divided into two groups according to the random number method:30 cases in HT⁃ESPB group and 30 cases in STB group.The intraoperative analgesic drug dosage,extubation time,diaphragmatic block,and complications,the rest and active VAS scores at 2 h,6 h,12 h,24 h,48 h,72 h after surgery,tramadol analgesic remediation,patient postoperative analgesic satisfaction scores,QoR⁃15 scores at 24 h,48 h,and 72 h postoperatively,occurrence of adverse effects were recorded.Results In HT⁃ESPB group,intraoperative Sufentanil dosage[(21.5±11.1)μg vs.(15.6±10.3)μg,P=0.037],and the postoperative tramadol dosage[(36.9±10.2)mg vs.(25.4±9.5)mg,P<0.001]were significantly higher than those in the STB group.The incidence of phrenic nerve block was significantly lower(0 vs.80%,P<0.001),and the QoR⁃15 score at 24 h after operation was significantly higher(76.3±12.2 vs.66.4±11.6,P=0.003)in the HT⁃ESPB group than those in the STB group.There were no significant differences in VAS scores at rest and during activity,analgesia satisfaction scores,and complication rates between two groups.Conclusion For patients undergoing shoulder arthroscopy under general anesthesia,although HT⁃ESPB requires more analgesic remediation,it provided similarly effective anesthesia as STB,with a significantly lower incidence of diaphragmatic block than STB.HT⁃ESPB is a viable alternative method to STB.