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| 超声引导下竖脊肌平面阻滞和胸椎旁神经阻滞用于胸腔镜下肺叶切除术的比较 |
| Comparison of ultrasound-guided erector spinae plane block versus thoracic paravertebral nerve block in patients undergoing thoracoscopic lobectomy |
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| DOI：10.12089/jca.2020.02.009 |
| 中文关键词: 竖脊肌平面阻滞 胸椎旁神经阻滞 胸腔镜肺叶切除术 血流动力学 术后镇痛 |
| 英文关键词: Erector spinae plane block Thoracic paravertebral nerve block Thoracoscopic lobectomy Haemodynamics Postoperative analgesia |
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| 中文摘要: |
目的 比较超声引导下竖脊肌平面阻滞(erector spinae plane block, ESPB)和胸椎旁神经阻滞(thoracic paravertebral nerve block, TPVB)应用于胸腔镜下肺叶切除术中血流动力学变化及术后联合PCIA的效果。
方法 选择行胸腔镜下肺叶切除术的患者60例,男38例,女22例,年龄18～64岁,BMI 18～24 kg／m2,ASA Ⅰ或Ⅱ级,随机分为ESPB组(E组)和TPVB组(T组),每组30例。E组术前0.4％罗哌卡因25 ml行超声引导下单次ESPB,T组术前0.4％罗哌卡因25 ml行单次TPVB。罗哌卡因注入20 min后用冰块测定阻滞平面。术毕两组均给予PCIA至术后48 h。记录穿刺时间、深度;记录术中血管活性药使用情况、丙泊酚、瑞芬太尼用量;记录镇痛泵首次按压时间、有效按压次数、曲马多补救例数;记录胸闷、皮肤瘙痒等术后不良反应的发生情况。
结果 与T组比较,E组穿刺时间明显缩短(P＜0.05),穿刺深度明显变浅(P＜0.05),术中去氧肾上腺素使用率明显降低(P＜0.05)。两组术中丙泊酚、瑞芬太尼用量、镇痛泵首次按压时间、有效按压次数、曲马多补救率及术后不良反应差异无统计学意义。
结论 超声引导下ESPB较TPVB操作更简单快捷,术中低血压发生率更低,术后两种阻滞联合PCIA均能为胸腔镜肺叶切术患者提供有效的镇痛。 |
| 英文摘要: |
Ojective To compare the efficacy of ultrasound-guided erector spinae plane block (ESPB) with thoracic paravertebral nerve block (TPVB) for haemodynamics and combined with patient-controlled intravenous analgesia (PCIA) on postoperative analgesia in patients undergoing thoracoscopic lobectomy.
Methods Sixty patients undergoing thoracoscopic lobectomy surgery, 38 males and 22 females, aged 18-64 years, with a BMI 18-24 kg／m2, falling into ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups: group E and group T, 30 cases in each group. ESPB was performed with 0.4％ ropivacaine 25 ml before the anesthesia induction in group E, and TPVB was given 0.4％ ropivacaine 25 ml before the anesthesia induction in group T. The block range was determined by loss of cold sensation 20 min after ropivacaine injection. PCIA was given to both groups within 48 h after surgery. The duration and depth about block were recorded. The frequency of intraoperative vasoactive drugs, propofol and remifentanil dosage were recorded. The time of first press, the frequency of pressing PCIA, the frequency oftramadol medication, adverse reactions such as chest tightness and itchy skin were documented.
Results Compared with group T, the length of nerve block was shorter and the depth was shallower, the frequency of phenylephrine was lower in group E (P ＜ 0.05). There was no statistically significant difference in the propofol or remifentanil dosage, the time of first press, the frequency of pressing PCIA, the frequency of tramadol medication between the two groups. There was no statistically significant difference of adverse reactions between the two groups.
Conclusion Both ultrasound guided ESPB and TPVB combined with PCIA are both effective for postoperative analgesia in patients undergoing thoracoscopic surgery, but ESPB is easier and quicker to operate and has less hypotension than TPVB. |
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