Abstract：
BACKGROUND: Thoracic paravertebral block (TPVB) is an analgesic method recommended in the enhanced recovery after surgery (ERAS) protocol and proven successful in thoracoscopic surgery. The study aimed to investigate whether the erector spinae plane block (ESPB) administered single-injection in uniportal video-assisted thoracoscopic surgery (VATS) can be an alternative to TPVB as an analgesic method.
METHODS: In this study, American Society of Anesthesiologists (ASA) physical status class I-II-III patients aged between 18-70 years who underwent thoracoscopic wedge resection surgery were analyzed retrospectively; 136 patients in the ESPB group and 114 patients in the TPVB group were included in the study. Postoperative cumulative morphine consumption numerical rating scale (NRS) scores were compared at 1, 6, 12, and 24 hours after surgery at rest and during coughing between the groups. Also, rescue analgesia requirements, postoperative nausea, vomiting and other complications were evaluated.
RESULTS: The mean cumulative morphine consumption in the postoperative 24 hours was 20.06 mg in the ESPB group and 11.35 mg in the TPVB group. A statistically significant difference was observed between groups in terms of total morphine consumption in the postoperative 24 hours (P<0.001). NRS score was significantly lower in the TPVB group at postoperative 6th and 24th hours during coughing (P=0.003 and P=0.034, respectively) and at 24th hour at rest (P=0.008) than ESPB group. Median NRS scores at rest were low (<4) in both groups. There was no significant difference between the groups in terms of postoperative pulmonary complications as atelectasis and length of hospital stay (LOS) (P=0.643 and P=0.867 respectively).
CONCLUSIONS: Ultrasound (US)-guided single-injection TPVB provided superior analgesia in patients undergoing single-port VATS than ESPB. In addition to this, TPVB showed more opioid sparing by reducing morphine consumption.
METHODS: In this study, American Society of Anesthesiologists (ASA) physical status class I-II-III patients aged between 18-70 years who underwent thoracoscopic wedge resection surgery were analyzed retrospectively; 136 patients in the ESPB group and 114 patients in the TPVB group were included in the study. Postoperative cumulative morphine consumption numerical rating scale (NRS) scores were compared at 1, 6, 12, and 24 hours after surgery at rest and during coughing between the groups. Also, rescue analgesia requirements, postoperative nausea, vomiting and other complications were evaluated.
RESULTS: The mean cumulative morphine consumption in the postoperative 24 hours was 20.06 mg in the ESPB group and 11.35 mg in the TPVB group. A statistically significant difference was observed between groups in terms of total morphine consumption in the postoperative 24 hours (P<0.001). NRS score was significantly lower in the TPVB group at postoperative 6th and 24th hours during coughing (P=0.003 and P=0.034, respectively) and at 24th hour at rest (P=0.008) than ESPB group. Median NRS scores at rest were low (<4) in both groups. There was no significant difference between the groups in terms of postoperative pulmonary complications as atelectasis and length of hospital stay (LOS) (P=0.643 and P=0.867 respectively).
CONCLUSIONS: Ultrasound (US)-guided single-injection TPVB provided superior analgesia in patients undergoing single-port VATS than ESPB. In addition to this, TPVB showed more opioid sparing by reducing morphine consumption.
摘要：
背景：胸椎旁阻滞（TPVB）是增强术后恢复（ERAS）方案中推荐的一种镇痛方法，在胸腔镜手术中被证明是成功的。该研究旨在研究在单孔视频辅助胸腔镜手术（VATS）中单次注射的竖脊肌平面阻滞（ESPB）是否可以替代TPVB作为镇痛方法。
方法：在本研究中，回顾性分析美国麻醉师协会（ASA）的身体状况I-II-III级患者，年龄在18-70岁之间，接受胸腔镜楔形切除术；ESPB组136例患者和TPVB组114例患者被纳入研究。比较两组患者术后1、6、12和24小时休息时和咳嗽时的术后累积吗啡消耗量数字评定量表（NRS）评分。此外，抢救镇痛要求,术后恶心,评估呕吐和其他并发症。
结果：术后24小时平均累积吗啡消耗量ESPB组为20.06mg，TPVB组为11.35mg。术后24小时吗啡总消耗量组间差异有统计学意义(P<0.001)。与ESPB组相比，TPVB组在咳嗽术后第6小时和第24小时（分别为P=0.003和P=0.034）和休息24小时（P=0.008）的NRS评分明显降低。两组休息时的NRS中位数得分均较低（<4）。两组之间在术后肺部并发症如肺不张和住院时间（LOS）方面没有显着差异（分别为P=0.643和P=0.867）。
结论：超声（US）引导下单次注射TPVB在单孔VATS患者中的镇痛效果优于ESPB。除此之外,通过减少吗啡的消耗，TPVB显示出更多的阿片类药物节省。
方法：在本研究中，回顾性分析美国麻醉师协会（ASA）的身体状况I-II-III级患者，年龄在18-70岁之间，接受胸腔镜楔形切除术；ESPB组136例患者和TPVB组114例患者被纳入研究。比较两组患者术后1、6、12和24小时休息时和咳嗽时的术后累积吗啡消耗量数字评定量表（NRS）评分。此外，抢救镇痛要求,术后恶心,评估呕吐和其他并发症。
结果：术后24小时平均累积吗啡消耗量ESPB组为20.06mg，TPVB组为11.35mg。术后24小时吗啡总消耗量组间差异有统计学意义(P<0.001)。与ESPB组相比，TPVB组在咳嗽术后第6小时和第24小时（分别为P=0.003和P=0.034）和休息24小时（P=0.008）的NRS评分明显降低。两组休息时的NRS中位数得分均较低（<4）。两组之间在术后肺部并发症如肺不张和住院时间（LOS）方面没有显着差异（分别为P=0.643和P=0.867）。
结论：超声（US）引导下单次注射TPVB在单孔VATS患者中的镇痛效果优于ESPB。除此之外,通过减少吗啡的消耗，TPVB显示出更多的阿片类药物节省。
