单孔胸腔镜肺部手术应用布比卡因脂质体行肋间神经阻滞镇痛效果的前瞻性研究

Effectiveness of intercostal nerve block and analgesia with bupivacaine liposomes in single-port thoracoscopic lung surgery:A prospective study

目的比较脂质体布比卡因(LB)与盐酸布比卡因在单孔胸腔镜肺部手术中行肋间神经阻滞后的镇痛效果、时间及不良反应发生率。方法选择2023年9月—2024年3月新乡医学院第一附属医院胸外科择期行单孔胸腔镜肺手术患者228例,按随机数字表法将患者分为两组:盐酸布比卡因组(B组,n=118)和LB组(n=110)。于术中在腔镜下行肋间神经阻滞,术后清醒拔管后送麻醉后恢复室(PACU),评估记录术后首次使用镇痛药物时间,术后72 h阿片类药物累计使用量,术后恶心、呕吐的发生率以及住院时间等指标。结果LB组患者4 h、8 h、12 h、24 h、48 h、72 h的视觉模拟评分(VAS)明显低于B组患者(P<0.05)。B组术后48 h内活动总次数明显少于LB组(P<0.05),术后住院时间LB组短于B组,但差异无统计学意义,两组术后不良反应差异也无统计学意义(P>0.05)。结论LB在单孔肺部手术中进行肋间神经阻滞能够降低患者术后疼痛,提高患者生活质量,促进患者康复,值得临床推广。

Objective To compare the analgesic effect,duration and incidence of adverse reactions of liposome bupivacaine(LB)and bupivacaine hydrochloride after intercostal nerve block in single-port thoracoscopic lung surgery.Methods In Department of Thoracic Surgery of the First Affiliated Hospital of Xinxiang Medical University between September 2023 and March 2024,228 patients who needed to undergo thoracoscopic lung surgery were selected and divided into two groups by random number table method:a group B with bupivacaine hydrochloride(n=118),and a group LB with LB(n=110).Intraoperative intercostal nerve block was performed under endoscopy,and the time of first use of analgesic drugs after surgery,cumulative use of opioids 72 h after surgery,incidence of postoperative nausea and vomiting,length of stay and other indicators were evaluated and recorded.Results Visual analogue scale(VAS)scores at 4 h,8 h,12 h,24 h,48 h and 72 h in the LB group were significantly lower than those in the group B(P<0.05).The total number of activities within 48 h after surgery in the group B was significantly lower than that in the LB group(P<0.05),and the postoperative hospitalization stay in the LB group was shorter than that in the group B,but the difference was not statistically significant.There was no statistical difference between the two groups in postoperative adverse reactions.Conclusion Intercostal nerve block with LB during single-port thoracoscopic lung surgery can significantly reduce postoperative pain,improve quality of life,and promote recovery of the patients.It is worthy of clinical application.