前锯肌平面阻滞与胸椎旁神经阻滞用于胸腔镜手术患者术后镇痛效果的比较
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摘要
目的比较前锯肌平面阻滞与胸椎旁神经阻滞用于胸腔镜手术患者术后的镇痛效果。方法选择择期行胸腔镜手术患者60例,男38例,女22例,年龄18～65岁,BMI 18～25kg/m2,ASAⅠ或Ⅱ级,采用随机数字表法分为前锯肌平面阻滞组(S组)和胸椎旁阻滞组(T组),每组30例。两组患者均采用支气管插管静脉全身麻醉,术后采用PCIA。S组于麻醉诱导前行超声引导下前锯肌平面阻滞,T组则行超声引导下胸椎旁阻滞,两组均使用0.4%罗哌卡因30ml,阻滞完成后30min使用针刺法测定并记录感觉阻滞平面;记录阻滞操作时间、起效时间、持续时间;记录术后2、4、8、12、24、48h的静息和咳嗽VAS评分;记录首次按压镇痛泵时间、术后48h内镇痛泵有效按压次数、舒芬太尼使用总量和哌替啶补救性镇痛例数;记录阻滞相关并发症、镇痛不良反应发生情况。结果与T组比较,S组阻滞操作时间明显缩短,阻滞持续时间明显延长(P<0.01);S组术后12h静息时和咳嗽时VAS评分明显降低(P<0.01),S组PCIA首次按压时间明显延长,S组PCIA 48h内按压次数、舒芬太尼使用量明显减少(P<0.01),两组气胸、恶心呕吐发生率差异无统计学意义。结论超声引导下前锯肌平面阻滞或胸椎旁阻滞均可为胸腔镜手术患者提供良好术后镇痛,但前锯肌平面阻滞较胸椎旁阻滞作用更持久、操作时间更短、并发症更少,且能有效减少患者术后对阿片类药物的需求量。
Objective To compare the postoperative analgesic effect between serratus plane block and thoracic paravertebral block in patients undergoing thoracoscopic surgery.Methods Sixty patients undergoing thoracoscopic surgery,38 males and 22 females,aged 18-65,BMI 18-25 kg/m2,falling into ASA physical status I or II.They were divided into groups S and T by random number table,30 cases in each group.Two groups of patients were treated with general anesthesia with endobronchial intubation and PCIA after operation.Group S performed Ultrasound-guided serratus plane block and group T performed thoracic paravertebral block,0.4%ropivacaine 30 ml were used in the two groups.The two groups of patients were observed 30 min after block,and the sensory block plane was measured with acupuncture and recorded.Recording operation time,onset time and duration of the block.Resting and cough VAS score were recorded at 2,4,8,12,24,and 48 hafter surgery.The first pressing time of the analgesic pump and times of press analgesic pump,the amount of sufentanil used and times the number of cases of useing piperidine were recorded within 48 hafter operation.Block related complications and analgesic related adverse reactions were recorded.Results Compared with group T,the operation time of the block obviously shortening but the duration obviously lengthening(P<0.01).Resting and cough VAS score at 12 hafter surgery significantly was lower(P<0.01).The first pressing time of the analgesic pump obviously lengthening,the number of press analgesic pump and the amount of sufentanil used significantly were reduced(P<0.01)in group S.Conclusion Ultrasound guided SP block and TPVB block can provide good postoperative analgesia for patients undergoing thoracoscopic surgery,but SP block is more durable,with less operation time and complications than TPVB block,and can effectively reduce the opioid demand and incidence of nausea and vomiting after operation.
Objective To compare the postoperative analgesic effect between serratus plane block and thoracic paravertebral block in patients undergoing thoracoscopic surgery.Methods Sixty patients undergoing thoracoscopic surgery,38 males and 22 females,aged 18-65,BMI 18-25 kg/m2,falling into ASA physical status I or II.They were divided into groups S and T by random number table,30 cases in each group.Two groups of patients were treated with general anesthesia with endobronchial intubation and PCIA after operation.Group S performed Ultrasound-guided serratus plane block and group T performed thoracic paravertebral block,0.4%ropivacaine 30 ml were used in the two groups.The two groups of patients were observed 30 min after block,and the sensory block plane was measured with acupuncture and recorded.Recording operation time,onset time and duration of the block.Resting and cough VAS score were recorded at 2,4,8,12,24,and 48 hafter surgery.The first pressing time of the analgesic pump and times of press analgesic pump,the amount of sufentanil used and times the number of cases of useing piperidine were recorded within 48 hafter operation.Block related complications and analgesic related adverse reactions were recorded.Results Compared with group T,the operation time of the block obviously shortening but the duration obviously lengthening(P<0.01).Resting and cough VAS score at 12 hafter surgery significantly was lower(P<0.01).The first pressing time of the analgesic pump obviously lengthening,the number of press analgesic pump and the amount of sufentanil used significantly were reduced(P<0.01)in group S.Conclusion Ultrasound guided SP block and TPVB block can provide good postoperative analgesia for patients undergoing thoracoscopic surgery,but SP block is more durable,with less operation time and complications than TPVB block,and can effectively reduce the opioid demand and incidence of nausea and vomiting after operation.
引文
[1]Adhikary SD,Pruett A,Forero M,et al.Erector spinae plane block as an alternative to epidural analgesia for postoperative analgesia following video-assisted thoracoscopic surgery:a case study and a literature review on the spread of local anaesthetic in the erector spinae plane.Indian J Anaesth,2018,62(1):75-78.
[2]Shariat A,Bhatt H.Successful Use of Serratus Plane Block as Primary Anesthetic for Video-Assisted Thoracoscopic Surgery(VATS)-Assisted Pleural Effusion Drainage.J Cardiothorac Vasc Anesth,2018,32(1):e31-e32.
[3]Xu J,Yang X,Hu X,et al.Multilevel Thoracic Paravertebral Block Using Ropivacaine With/Without Dexmedetomidine in Video-Assisted Thoracoscopic Surgery.J Cardiothorac Vasc Anesth,2018,32(1):318-324.
[4]韩超,任鸿飞,周敏敏,等.超声引导下前锯肌平面阻滞对乳腺癌根治术患者术后镇痛的影响.临床麻醉学杂志,2016,32(12):1173-1176.
[5]邓康,许世杰,钱燕飞,等.前锯肌平面阻滞自控镇痛在胸腔镜术后的应用.中华医学杂志,2018,98(8):570-575.
[6]Blanco R,Parras T,McDonnell JG,et al.Serratus plane block:a novel ultrasound-guided thoracic wall nerve block.Anaesthesia.2013,68(11):1107-1113.
[7]Kim DH,Oh YJ,Lee JG,et al.Efficacy of ultrasoundguided serratus plane block on postoperative quality of recovery and analgesia after video-Assisted thoracic surgery:a randomized,triple-Blind,placebo-controlled study.Anesth Analg,2018,126(4):1353-1361.
[8]TakimotoK,NishijimaK,OnoM.Serratus plane block for persistent pain after partial mastectomy and axillary node dissection.Pain Physician,2016,19(3):E481-E486.
[9]张庆芬,张冉,何苗,等.我国围术期疼痛治疗及管理现状调查.中华麻醉学杂志,2017,37(12):1409-1413.
[10]朱阿芳,申乐,许力,等.开胸手术后慢性疼痛的危险因素.临床麻醉学杂志,2018,34(4):397-400.
[11]Mayes J,Davison E,Panahi P,et al.An anatomical evaluation of the serratus anterior plane block.Anaesthesia,2016,71(9):1064-1069.
[12]Kunigo T,Murouchi T,Yamamoto S,et al.Spread of injectate in ultrasound-guided serratus plane block:a cadaveric study.JA Clin Rep,2018,4(1):10.
[13]高艳丽,张宝奇.瑞舒伐他汀对盐酸羟考酮缓释片治疗晚期非小细胞肺癌患者癌痛的增效作用和安全性研究.中国全科医学,2016,19(27):3265-3269.
[14]Yang Y,Chen M.Statistical analysis regarding:statins alleviate experimental nerve injury-induced neuropathic pain.Pain,2015,156(7):1366.
[2]Shariat A,Bhatt H.Successful Use of Serratus Plane Block as Primary Anesthetic for Video-Assisted Thoracoscopic Surgery(VATS)-Assisted Pleural Effusion Drainage.J Cardiothorac Vasc Anesth,2018,32(1):e31-e32.
[3]Xu J,Yang X,Hu X,et al.Multilevel Thoracic Paravertebral Block Using Ropivacaine With/Without Dexmedetomidine in Video-Assisted Thoracoscopic Surgery.J Cardiothorac Vasc Anesth,2018,32(1):318-324.
[4]韩超,任鸿飞,周敏敏,等.超声引导下前锯肌平面阻滞对乳腺癌根治术患者术后镇痛的影响.临床麻醉学杂志,2016,32(12):1173-1176.
[5]邓康,许世杰,钱燕飞,等.前锯肌平面阻滞自控镇痛在胸腔镜术后的应用.中华医学杂志,2018,98(8):570-575.
[6]Blanco R,Parras T,McDonnell JG,et al.Serratus plane block:a novel ultrasound-guided thoracic wall nerve block.Anaesthesia.2013,68(11):1107-1113.
[7]Kim DH,Oh YJ,Lee JG,et al.Efficacy of ultrasoundguided serratus plane block on postoperative quality of recovery and analgesia after video-Assisted thoracic surgery:a randomized,triple-Blind,placebo-controlled study.Anesth Analg,2018,126(4):1353-1361.
[8]TakimotoK,NishijimaK,OnoM.Serratus plane block for persistent pain after partial mastectomy and axillary node dissection.Pain Physician,2016,19(3):E481-E486.
[9]张庆芬,张冉,何苗,等.我国围术期疼痛治疗及管理现状调查.中华麻醉学杂志,2017,37(12):1409-1413.
[10]朱阿芳,申乐,许力,等.开胸手术后慢性疼痛的危险因素.临床麻醉学杂志,2018,34(4):397-400.
[11]Mayes J,Davison E,Panahi P,et al.An anatomical evaluation of the serratus anterior plane block.Anaesthesia,2016,71(9):1064-1069.
[12]Kunigo T,Murouchi T,Yamamoto S,et al.Spread of injectate in ultrasound-guided serratus plane block:a cadaveric study.JA Clin Rep,2018,4(1):10.
[13]高艳丽,张宝奇.瑞舒伐他汀对盐酸羟考酮缓释片治疗晚期非小细胞肺癌患者癌痛的增效作用和安全性研究.中国全科医学,2016,19(27):3265-3269.
[14]Yang Y,Chen M.Statistical analysis regarding:statins alleviate experimental nerve injury-induced neuropathic pain.Pain,2015,156(7):1366.