布比卡因脂质体超声引导下竖脊肌平面阻滞用于胸腔镜手术患者的临床观察

Clinical observation of erector spinae plane block guided by bupivacaine liposome in thoracoscopic surgery

目的比较布比卡因脂质体和罗哌卡因行竖脊肌平面阻滞(ESPB),应用于胸腔镜手术后的镇痛效果及镇痛时间。方法选取2024年2~5月在国药葛洲坝中心医院行胸腔镜下肺叶切除术的患者60例,性别不限,年龄18~65岁,BMI<30 kg/m 2,ASA分级Ⅰ~Ⅲ级,采用随机数字表法将患者分为布比卡因脂质体组(n=30)和罗哌卡因组(n=30)。两组患者均在侧卧位下行超声引导下竖脊肌平面阻滞,布比卡因脂质体组采用布比卡因脂质体266 mg配伍生理盐水至30 mL,罗哌卡因组则采用罗哌卡因100 mg配伍生理盐水至30 mL。两组患者术后均采用PCIA镇痛。记录PCA首次按压时间、术后按压次数及补救镇痛次数;术后2 h(T_(1))、6 h(T_(2))、12 h(T_(3))、24 h(T_(4))、36 h(T_(5))、48 h(T_(6))、72 h(T_(7))静息和活动时(咳嗽)NRS疼痛评分及术后不良反应的发生情况。结果与罗哌卡因组相比,布比卡因脂质体组术后PCA按压次数及其他镇痛药物补救次数明显低于罗哌卡因组,差异有统计学意义(P<0.05);布比卡因脂质体组的首次PCA时间晚于罗哌卡因组,差异有统计学意义(P<0.05);术后T_(3)、T_(4)、T_(5)、T_(6)、T_(7)静息和活动时NRS疼痛评分降低,差异有统计学意义(P<0.05);布比卡因脂质体组术后72 h内并发症发生率明显低于罗哌卡因组,差异有统计学意义(P<0.05)。结论布比卡因脂质体行超声引导下ESPB,可安全有效的应用于胸科手术术后镇痛,相较于罗哌卡因,可提供更长时间的镇痛效果。

Objective To compare the analgesic effect and duration of bupivacaine liposome and ropivacaine in erector spinae plane block(ESPB)after thoracoscopic surgery.Methods A total of 60 patients of either gender,aged 18-65 years,with BMI less than 30 kg/m 2,ASAⅠ-Ⅲ,receiving thoracoscopic pulmonary lobectomy in Gezhouba Central Hospital of Sinopharm,from February to May 2024 were selected and randomly divided into the bupivacaine liposome group(n=30)and the ropivacaine group(n=30).Patients in both groups were received ESPB under the guidance of ultrasound under lateral position.The bupivacaine liposome group received bupivacaine liposome 266 mg combined with normal saline for a total of 30 mL,and the ropivacaine group received ropivacaine 100 mg combined with normal saline for a total of 30 mL.Sufentanil was prepared with PCIA standard body weight for postoperative analgesia in both groups without setting background dose.The first compression time of PCA time,times of compressions and times of relief analgesia were recorded.The resting and movement NRS pain scores and the occurrence of postoperative complications was recorded at 2 h(T_(1)),6 h(T_(2)),12 h(T_(3)),24 h(T_(4)),36 h(T_(5)),48 h(T_(6))and 72 h(T_(7))postoperatively.Results Compared with the ropivacaine group,the times of PCA compression and relief analgesia of the bupivacaine liposome group were less(P<0.05);the resting and movement NRS pain scores were lower at T_(3),T_(4),T_(5),T_(6),T_(7)(P<0.05);and the postoperative complications of the group LB was less(P<0.05).Conclusion Bupivacaine liposomes can be used safely and effectively for postoperative analgesia in thoracic surgery,and can provide longer analgesia effect than ropivacaine.