目的:探讨超声引导下竖脊肌平面阻滞(ESPB)对胸腔镜肺叶切除术患者急慢性术后疼痛的影响。
方法:共94例患者,2021年8月至2021年12月择期行单侧胸腔镜下肺叶白质切除术的患者随机分为全身麻醉组(A组,n=46)和ESPB复合全麻组(B组,n=48)通过计算机。两组术后均进行静脉自控镇痛(PCIA)。麻醉后监护病房(PACU)休息和咳嗽疼痛的数字评定量表(NRS),2h,6h,12h,术后24和48h,术后24小时PCIA频率,抢救镇痛的频率,患者满意度,记录两组患者的不良反应及并发症发生情况。术后3个月和6个月慢性疼痛的发生率,记录两组的日常生活效果和慢性疼痛管理措施评分。
结果:与A组相比,2小时休息和咳嗽NRS评分,6h,12h,手术后24和48小时,手术后24小时PCIA的使用频率,B组抢救镇痛次数明显减少(P<0.05)。2组患者在麻醉后监护病房术后PACU休息、咳嗽NRS评分比较差异无统计学意义(P>0.05)。两组术后慢性疼痛发生率比较差异无统计学意义(P>0.05);B组术后慢性疼痛对日常生活的影响及疼痛管理措施均明显低于A组(P<0.05)。与A组相比,B组患者满意度较高,术后恶心和呕吐(PONV)的发生率较低,麻醉苏醒期躁动发生率较低(P<0.05)。没有气胸,2组血肿及局麻药毒性。
结论:超声引导下的竖脊肌平面阻滞可明显减轻术后急性疼痛,不能降低术后慢性疼痛的发生率,但可显著减轻电视胸腔镜肺叶切除术患者慢性疼痛的严重程度。
背景:ChiCTR2100050313,注册日期:2021年8月26日。
To investigate the effects of ultrasound-guided erector spinae plane block (ESPB) on acute and chronic post-surgical pain in patients underwent video-assisted thoracoscopic lobectomy.
A total of 94 patients, who underwent elective unilateral video-assisted thoracoscopic lobotomy from August 2021 to December 2021 were randomly divided into general anesthesia group (group A, n = 46) and ESPB combined with general anesthesia group (group B, n = 48) by computer. Patient controlled intravenous analgesia(PCIA) was performed in both groups after operation. The numerical rating scale(NRS) of rest and cough pain at post anesthesia care unit(PACU), 2 h, 6 h, 12 h, 24 and 48 h after operation, frequency of PCIA in 24 h after operation, frequency of rescue analgesia, patient satisfaction, adverse reactions and complications were recorded in the two groups. Incidence of chronic pain at 3 months and 6 months after operation, the effect of daily life and rating of chronic pain management measures were recorded in the two groups.
Compared with group A, rest and cough NRS score at 2 h, 6 h, 12 h, 24 and 48 h after surgery, frequency of PCIA use at 24 h after surgery, frequency of rescue analgesia were significantly decreased in group B (P < 0.05). There was no significant difference in NRS scores of rest and cough at PACU after operation between 2 groups after surgery at post anesthesia care unit (P > 0.05). There were no significant differences in the incidence of postoperative chronic pain between the 2 groups(P > 0.05);The effect of postoperative chronic pain on daily life and pain management measures in group B were significantly lower than those in group A(P < 0.05). Compared with group A, patients in group B had higher satisfaction degree, lower incidence of postoperative nausea and vomiting(PONV), and lower incidence of agitation during anesthesia recovery (P < 0.05). There were no pneumothorax, hematoma and toxicity of local anesthetic in the 2 groups.
Ultrasound-guided erector spinae plane block can significantly reduce acute post-surgical pain, can not reduce the incidence of chronic post-surgical pain, but can significantly reduce the severity of chronic pain in patients underwent video-assisted thoracoscopic lobectomy.
ChiCTR2100050313,date of registration:26/08/2021.