超声引导菱形肌-肋间肌阻滞和TPVB在电视胸腔镜手术术后早期疼痛控制中的应用比较

Comparison of ultrasound-guided rhomboid-intercostal muscle block and TPVB in early postoperative pain control after television thoracoscopic surgery

目的 比较超声引导下菱形肌-肋间肌阻滞和胸椎旁神经阻滞(TPVB)对电视胸腔镜手术患者术后早期疼痛的控制效果。方法 前瞻性选取2022年1月至2023年7月秦皇岛市第一医院收治的120例行电视胸腔镜手术治疗的患者作为研究对象,按照信封法分为观察组(n=61)和对照组(n=59)。观察组采用静脉全身麻醉+超声引导菱形肌-肋间肌阻滞麻醉,对照组采用静脉全身麻醉+超声引导TPVB麻醉。比较两组患者手术指标、神经阻滞情况、视觉模拟评分法(VAS)评分、Ramsay镇静评分,统计两组患者并发症发生情况。结果 两组患者手术时间、术中出血量、引流时间、住院时间及首次进食时间比较,差异均无统计学意义(P>0.05)。两组注药时间、阻滞持续时间及补救镇痛次数比较,差异均无统计学意义(P>0.05);观察组超声定位时间、穿刺时间、操作总时间分别为(1.12±0.10)、(2.37±0.56)、(5.47±0.38)min,均短于对照组[(1.65±0.14)、(3.61±0.64)、(6.98±0.42) min],穿刺针深度为(4.43±0.52) mm,小于对照组[(5.37±0.58)mm],差异均有统计学意义(P<0.05)。两组患者术后6、12 h VAS评分、Ramsay镇静评分比较,差异均无统计学意义(P>0.05)。两组患者麻醉后恢复室(PACU)低氧血症发生率、气胸发生率、肺部感染发生率、肺不张发生率、恶心呕吐发生率及总并发症发生率比较,差异均无统计学意义(P>0.05)。结论 与TPVB比较,超声引导菱形肌-肋间肌阻滞应用于电视胸腔镜手术,患者术后恢复质量、镇痛效果及安全性相当,但超声引导菱形肌-肋间肌阻滞操作简单,操作时间更短。

Objective To compare the effect of ultrasound-guided rhomboid block and thoracic paravertebral nerve block(TPVB) on early postoperative pain control in patients undergoing thoracoscopic surgery.Methods A total of 120 patients who underwent video-assisted thoracoscopic surgery at the First Hospital of Qinhuangdao from January 2022 to July 2023 were prospectively selected as the study subjects and divided into the observation group(n=61) and the control group(n=59) according to the envelope method.The observation group received ultrasound guided diamond-intercostal block anesthesia,the control group received ultrasound guided TPVB anesthesia.The surgical index,nerve block condition,visual analogue scale(VAS) score,Ramsay sedation score of the two groups were compared,and the occurrence of complications in the two groups of patients were analyzed.Results There were no statistically significant difference between the two groups of patients in terms of surgical time,intraoperative blood loss,drainage time,hospital stay,and first meal time(P>0.05).There were no statistically significant difference between the two groups in terms of injection time,duration of block,and frequency of remedial analgesia(P>0.05);the ultrasound localization time,puncture time,and total operation time in the observation group were(1.12±0.10),(2.37±0.56),and(5.47±0.38) minutes,respectively,which were shorter than those in the control group [(1.65±0.14),(3.61±0.64),and(6.98±0.42) minutes],the depth of the puncture needle was(4.43±0.52) mm,which was smaller than that in the control group [(5.37±0.58) mm],the differences were statistically significant(P<0.05).There were no statistically significant difference in VAS score and Ramsay sedation score between the two groups of patients at 6 and 12 hours after surgery(P>0.05).There were no statistically significant differences in the incidence of hypoxemia in the post-anesthesia recovery unit(PACU),pneumothorax,pulmonary infection,atelectasis,nausea and vomiting,and overall complications between the two groups of patients(P>0.05).Conclusion Compared with TPVB,ultrasound guided rhomboide-intercostal block applied in video-assisted thoracoscopic surgery has the same postoperative recovery quality,analgesic effect and safety,but the operation is simple and the operation time is shorter.