网络出版日期: 2021-06-18
Analgesic effect of multiple spinal nerve block on video-assisted thoracoscopic segmentectomy or lobectomy
Online published: 2021-06-18
目的·研究复合脊神经阻滞对单孔胸腔镜下肺段/叶切除术后切口痛和内脏痛的镇痛效果及安全性。方法·连续入选2020年5月—10月于上海交通大学医学院附属瑞金医院择期全身麻醉下行单孔胸腔镜下肺段/叶切除术的121例患者，随机分为单点胸椎旁阻滞（thoracic paravertebral block，TPVB）组（T组，60例）和复合脊神经阻滞组（multiple spinal nerve block group，M组；61例）。T组使用0.3%罗哌卡因40 mL行超声引导下第5胸椎水平单点TPVB；M组使用0.3%罗哌卡因行超声引导下四点法神经阻滞（第5肋间水平前锯肌平面阻滞10 mL，第5胸椎水平竖脊肌平面阻滞10 mL，第5胸椎水平椎板阻滞10 mL，第3胸椎水平椎板阻滞10 mL）。比较2组患者围手术期血流动力学参数、术后皮肤切口痛与内脏痛数字评分量表（numeric rating scale，NRS）评分、不良反应等。结果·2组患者的一般临床资料、术中血流动力学参数及血管活性药使用情况差异均无统计学意义（均P>0.05）。M组术后24 h静息及咳嗽时皮肤和内脏NRS评分较T组降低（静息时：皮肤P=0.001，内脏P=0.000。咳嗽时：皮肤P=0.000，内脏P=0.000），术后48 h咳嗽时内脏NRS评分较T组降低（P=0.006）。与T组比较，M组术后48 h内患者自控静脉镇痛按压次数减少（P=0.000），术后48 h内氟比洛芬使用量减少（P=0.000），术后首次疼痛出现时间出现推迟（P=0.002），术后首次下床时间提前（P=0.000），术后48 h内呕吐发生率降低（P=0.025），差异均有统计学意义。结论·复合脊神经阻滞对单孔胸腔镜下肺段/叶切除术后切口痛和内脏痛的镇痛效果显著优于TPVB，其临床安全性与TPVB相同。
王子涵 , 沈杰 , 罗艳 . 复合脊神经阻滞用于单孔胸腔镜下肺段/叶切除术的镇痛效果[J]. 上海交通大学学报（医学版）, 2021 , 41(8) : 1062 -1067 . DOI: 10.3969/j.issn.1674-8115.2021.08.011
·To investigate the analgesic effect and clinical safety of multiple spinal nerve block in incision pain and visceral pain in patients undergoing video-assisted thoracoscopic segmentectomy or lobectomy.
·From May 2020 to October 2020, 121 consecutive general anaesthesia patients scheduled for video-assisted thoracoscopic segmentectomy or lobectomy in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were allocated to thoracic paravertebral block (TPVB) group (group T, n=60) or multiple spinal nerve block group (group M, n=61). Group T received ultrasound-guided TPVB on the T5 level with 40 mL 0.3% ropivacaine. Group M received ultrasound-guided multiple spinal nerve block including serratus anterior plane block on the 5th intercostal space with 10 mL 0.3% ropivacaine, erector spinae plane block on the T5 level with 10 mL 0.3% ropivacaine, retrolaminar block on the T5 level with 10 mL 0.3% ropivacaine, and retrolaminar block on the T3 level with 10 mL 0.3% ropivacaine. Perioperative hemodynamic characters, postoperative Numeric Rating Scale (NRS) scores of incision pain and visceral pain, and major adverse events were compared between the two groups.
·There was no significant difference in clinical characteristics, perioperative hemodynamic characters, and the use and dose of intraoperative analgesics or vasoactive drugs between the two groups (P>0.05). The NRS scores of incision pain and visceral pain in group M were lower than those in group T during postoperative 24 h (Calm: incision pain, P=0.001; visceral pain, P=0.000. Coughing: incision pain, P=0.000; visceral pain, P=0.000). NRS scores of visceral during pain postoperative 48 h in group M were significantly lower than those of group T (P=0.006) when coughing. Compared with group T, the pressing times of patient-controlled intravenous analgesia pump and the usage of flurbiprofen decreased in group M within 48 h after operation (both P=0.000), and the time of first postoperative pain was delayed (P=0.002). The postoperative activity time was advanced (P=0.000), and the incidence of vomiting decreased within 48 h after operation (P=0.025).
·Multiple spinal nerve block has better analgesic effect on video-assisted thoracoscopic segmentectomy or lobectomy than TPVB, which relieves both incision pain and visceral pain. There is no difference in clinical safety between the multiple spinal nerve block and TPVB.
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