超声引导下横突间阻滞与胸椎旁神经阻滞对双孔胸腔镜手术围术期镇痛的效果比较

Comparison of the effects of ultrasound-guided intertransverse process block and paravertebral nerve block on perioperative analgesia in two-port video-assisted thoracoscopic surgery

目的比较超声引导下横突间阻滞(ITPB)与胸椎旁神经阻滞(PVB)应用于双孔胸腔镜手术围术期镇痛的效果。方法招募2022年11月至2023年6月于盐城市第一人民医院择期行双孔胸腔镜下肺部分切除术的患者70例,采用随机数字表法将其分为观察组和对照组,每组35例。经剔除后,最终每组纳入34例进行分析。观察组行ITPB,对照组行PVB。比较两组切皮前后心率变化值、平均动脉压变化值,术中镇痛药的消耗量,拔管后30 min(T_(1))、4 h(T_(2))、8 h(T_(3))、16 h(T_(4))、24 h(T_(5))静息状态和活动状态的视觉模拟量表(VAS)评分,术后24 h吗啡当量消耗量、镇痛泵按压次数、补救镇痛次数,以及不良反应发生情况。结果与对照组相比,观察组神经阻滞时间缩短,差异有统计学意义(P<0.05)。两组切皮前后的心率变化值、平均动脉压变化值,以及术中芬太尼用量和瑞芬太尼用量比较差异无统计学意义(P>0.05)。两组术后24 h吗啡当量消耗量、镇痛泵按压次数、镇痛补救次数比较差异无统计学意义(P>0.05)。两组术后静息状态VAS评分和活动状态VAS评分均随着时间进展有所上升,但两组各时间点评分比较差异无统计学意义(P>0.05)。观察组穿刺血肿发生率显著低于对照组(P<0.05)。两组术中低血压、术后恶心呕吐发生率比较差异无统计学意义(P>0.05)。结论超声引导下ITPB在双孔胸腔镜手术围术期镇痛的效果与PVB相当,其发生穿刺血肿的风险更小,安全性更好,可作为PVB的替代疗法。

Objective To compare the analgesic effects of ultrasound-guided intertransverse process block(ITPB)and paravertebral nerve block(PVB)on perioperative analgesia in two-port video-assisted thoracoscopic surgery.Methods Seventy patients who underwent elective two-port thoracoscopic partial lung resection in Yancheng No.1 People's Hospital from November 2022 to June 2023 were recruited and divided into observation group and control group by random number table method,with 35 cases in each group.After excluding cases,34 cases were ultimately included in each group for analysis.The observation group underwent ITPB and the control group underwent PVB.Changes in values of heart rate and mean arterial pressure before and after skin incision,intraoperative analgesic consumption,Visual Analogue Scale(VAS)scores for resting state and active state 30 minutes(T_(1)),4 hours(T_(2)),8 hours(T_(3)),16 hours(T_(4))and 24 hours(T_(5))after extubation,morphine equivalent consumption,the number of analgesic pump compressions and the times of remedial analgesia 24 hours after surgery,and the occurrence of adverse reactions were compared between the two groups.Results The nerve block time in the observation group was shorter than that in the control group,and the difference was statistically significant(P<0.05).There were no significant differences in the changes in values of heart rate and mean arterial pressure before and after skin incision,and intraoperative dosage of fentanyl and dosage of remifentanil between the two groups(P>0.05).There were no significant differences in the morphine equivalent consumption,the number of analgesic pump compressions and the times of remedial analgesia 24 hours after surgery between the two groups(P>0.05).The postoperative VAS scores for resting state and active state in the two groups increased as time progressed,but there were no significant differences in the VAS scores between the two groups at each time point(P>0.05).The incidence rate of hematoma after puncture in the observation group was significantly lower than that in the control group(P<0.05),and there were no significant differences in the incidence rates of intraoperative hypotension and postoperative nausea and vomiting between the two groups(P>0.05).Conclusion The analgesic effect of ultrasound-guided ITPB during the perioperative period in two-port video-assisted thoracoscopic surgery is comparable to that of PVB,and the risk of hematoma after puncture in ultrasound-guided ITPB is lower and the safety is better.Ultrasound-guided ITPB can be used as an alternative therapy for PVB.