Abstract：
OBJECTIVE: To explore the effect of a single preoperative ultrasound-guided thoracic paravertebral nerve block (TPVB) and erector spinae plane block (ESPB) for perioperative analgesia in thoracoscopic pulmonary lobectomy.
METHODS: Seventy-two patients aged 40-70 years who underwent thoracoscopic pulmonary lobectomy under general anesthesia were enrolled and randomly divided into the control group (Group C), the TPVB group (Group T) and the ESPB group (Group E). The primary observation indicators included the visual analogue scale (VAS) at 1, 6, 12, 24, and 48 h postoperatively at rest and with a cough. The secondary observation indicators included the intraoperative sufentanil consumption, anesthesia awakening time and extubation time, the sufentanil consumption in the analgesic pump, and flurbiprofen ester consumption for remedial analgesia within 48 h after surgery and the incidence of postoperative adverse events.
RESULTS: The intraoperative sufentanil consumption, anesthesia awakening time, and extubation time were lower in groups T and E than those in group C (p < 0.05). Patients in group T had lower VAS scores at rest and with a cough at 1, 6, and 12 h postoperatively than in group C at the same time points (p < 0.05). The VAS scores at rest at 1 and 6 h postoperatively and coughing status at 1, 6, and 12 h postoperatively were lower in group E than in group C at the same time points (p < 0.05).
CONCLUSIONS: The ultrasound-guided preoperative single TPVB and ESPB for thoracoscopic pulmonary lobectomy could both reduce the postoperative pain VAS score and reduce the dose of perioperative sufentanil and postoperative remedial analgesics.
METHODS: Seventy-two patients aged 40-70 years who underwent thoracoscopic pulmonary lobectomy under general anesthesia were enrolled and randomly divided into the control group (Group C), the TPVB group (Group T) and the ESPB group (Group E). The primary observation indicators included the visual analogue scale (VAS) at 1, 6, 12, 24, and 48 h postoperatively at rest and with a cough. The secondary observation indicators included the intraoperative sufentanil consumption, anesthesia awakening time and extubation time, the sufentanil consumption in the analgesic pump, and flurbiprofen ester consumption for remedial analgesia within 48 h after surgery and the incidence of postoperative adverse events.
RESULTS: The intraoperative sufentanil consumption, anesthesia awakening time, and extubation time were lower in groups T and E than those in group C (p < 0.05). Patients in group T had lower VAS scores at rest and with a cough at 1, 6, and 12 h postoperatively than in group C at the same time points (p < 0.05). The VAS scores at rest at 1 and 6 h postoperatively and coughing status at 1, 6, and 12 h postoperatively were lower in group E than in group C at the same time points (p < 0.05).
CONCLUSIONS: The ultrasound-guided preoperative single TPVB and ESPB for thoracoscopic pulmonary lobectomy could both reduce the postoperative pain VAS score and reduce the dose of perioperative sufentanil and postoperative remedial analgesics.
摘要：
目的：探讨单纯术前超声引导下胸椎旁神经阻滞(TPVB)和竖脊肌平面阻滞(ESPB)用于胸腔镜肺叶切除术围术期镇痛的效果。
方法：选择72例40～70岁的全麻下行胸腔镜肺叶切除术患者，随机分为对照组（C组）。TPVB组(T组)和ESPB组(E组)。主要观察指标包括术后1、6、12、24和48h休息和咳嗽时的视觉模拟评分（VAS）。次要观察指标包括术中舒芬太尼消耗量、麻醉苏醒时间和拔管时间,镇痛泵中舒芬太尼的消耗量，和氟比洛芬酯在术后48h内用于补救镇痛的消耗量以及术后不良事件的发生率。
结果：术中舒芬太尼消耗量，麻醉苏醒时间,T组和E组的拔管时间均低于C组（p<0.05）。T组患者在静息时的VAS评分和术后1、6和12h咳嗽，在相同时间点低于C组（p<0.05）。术后1、6h静息时的VAS评分及术后1、6、12h咳嗽状态E组在相同时间点低于C组(p<0.05)。
结论：超声引导下术前单一TPVB和ESPB行胸腔镜肺叶切除术，既能降低术后疼痛VAS评分，又能减少围手术期舒芬太尼用量和术后镇痛药物的使用。
方法：选择72例40～70岁的全麻下行胸腔镜肺叶切除术患者，随机分为对照组（C组）。TPVB组(T组)和ESPB组(E组)。主要观察指标包括术后1、6、12、24和48h休息和咳嗽时的视觉模拟评分（VAS）。次要观察指标包括术中舒芬太尼消耗量、麻醉苏醒时间和拔管时间,镇痛泵中舒芬太尼的消耗量，和氟比洛芬酯在术后48h内用于补救镇痛的消耗量以及术后不良事件的发生率。
结果：术中舒芬太尼消耗量，麻醉苏醒时间,T组和E组的拔管时间均低于C组（p<0.05）。T组患者在静息时的VAS评分和术后1、6和12h咳嗽，在相同时间点低于C组（p<0.05）。术后1、6h静息时的VAS评分及术后1、6、12h咳嗽状态E组在相同时间点低于C组(p<0.05)。
结论：超声引导下术前单一TPVB和ESPB行胸腔镜肺叶切除术，既能降低术后疼痛VAS评分，又能减少围手术期舒芬太尼用量和术后镇痛药物的使用。
