罗哌卡因复合纳布啡行胸椎旁神经阻滞对胸腔镜手术患者术后急性疼痛和恢复质量的影响

Effect of paravertebral nerve block using ropivacaine combined with nalbuphine on acute pain and postoperative recovery quality of patients undergoing video-assisted thoracic surgery

目的探讨罗哌卡因复合纳布啡行胸椎旁神经阻滞(TPVB)对胸腔镜手术(VATS)患者术后急性疼痛以及恢复质量的影响。方法选择2023年8月-2024年2月本院收治的全麻下行VATS的60例患者作为研究对象,随机分为单纯罗哌卡因椎旁神经阻滞组(C组)与罗哌卡因复合纳布啡组(N组)两组,每组各30例。C组给予0.40%的罗哌卡因30 ml,N组给予0.40%的罗哌卡因+纳布啡20 mg共30 ml。分别记录术后1 h、3 h、6 h、12 h、24 h、48 h时刻静息和动态视觉模拟(VAS)评分,术后24 h内口服吗啡当量(OME)使用量,PCIA次数和补救性镇痛次数;记录术前、术后第1 d的15项恢复质量评分(QoR-15)和住院时间;记录术后24 h不良反应的发生率。结果与C组相比,N组术后6 h、12 h、24 h静息与运动状态下VAS评分均降低(P<0.05);与C组相比,N组术后OME降低(P<0.05),QoR-15评分更高(P<0.05);两组患者在PCIA次数、补救性镇痛次数、住院时间和术后不良反应发生率经比较,差异无统计学意义(P>0.05)。结论纳布啡作为TPVB中罗哌卡因的佐剂可减轻VATS术后急性疼痛,有效减少术后镇痛药物使用,可以提高患者术后恢复质量,且无明显的不良反应。

Objective To investigate the effects of thoracic paravertebral nerve block(TPVB)with ropivacaine combined with nalbuphine on postoperative acute pain and recovery quality of patients undergoing video-assisted thoracic surgery(VATS).Methods Sixty patients who received VATS under general anesthesia in our hospital from August 2023 to February 2024 were selected as study subjects and randomly divided into two groups:ropivacaine paravertebral nerve block group(group C)and ropivacaine combined with nalbuphine group(group N),with 30 cases in each group.Group C was given 0.40%ropivacaine at a total volume of 30ml.Group N was given 0.40%ropivacaine and nalbuphine 20mg at a total volume of 30ml.Resting and dynamic visual analogue(VAS)scores at 1,3,6,12,24 and 48 hours after surgery,the amount of oral morphine equivalent(OME),the number of patient-controlled intravenous analgesia(PCIA)and the number of remedial analgesia within 24 hours after surgery were recorded.The 15-item quality of recovery score(QoR-15)and length of hospital stay were recorded before surgery and on the first day after surgery.The incidence of adverse reactions within 24 hours after operation was also recorded.Results Compared to group C,VAS scores at rest and movement in group N were significantly decreased at 6 hours,12 hours,and 24 hours after surgery(P<0.05).Group N exhibited lower OME levels and higher QoR-15 scores compared to group C after surgery(P<0.05).There were no significant differences observed between the two groups in terms of PCIA usage,remedial analgesia requirements,hospital stay,or incidence of postoperative adverse reactions(P>0.05).Conclusions Nalbuphine as an adjuvant of ropivacaine in TPVB can effectively alleviate postoperative acute pain,reduce the requirement for postoperative analgesics,enhance patients'recovery quality,and exhibit no apparent adverse effects during the postoperative period.