目的:在本研究中,我们比较了肋间神经阻滞(ICNB)的镇痛效果,超声引导下椎旁神经阻滞(PVB),单孔胸腔镜肺手术后硬膜外阻滞(EB)。
方法:将120例单孔胸腔镜肺手术患者随机均分为3组:ICNB组,PVB组,EB集团。ICNB组于手术结束前在直接胸腔镜下进行,而PVB和EB组在全身麻醉后进行PVB和EB,分别。所有组术后均使用患者自控静脉镇痛(PCIA)。记录以下指标:术中舒芬太尼用量,麻醉苏醒时间,术后插管时间,神经阻滞手术时间,术后视觉模拟量表(VAS)疼痛评分在休息和咳嗽期间定期0、2、4、8、24和48h,直到第一次PCIA,术后24小时内有效按压次数,抢救镇痛干预措施的数量,和副作用。
结果:与ICNB组相比,PVB和EB组术中舒芬太尼剂量较低,麻醉苏醒时间明显缩短,术后插管时间,但是神经阻滞手术时间更长,术后24h内休息和咳嗽时,VAS评分较低(所有p值小于0.05)。相反,24h后休息和咳嗽期间的VAS评分无统计学差异(所有p值大于0.05).第一次PCIA的时间,PVB组和EB组术后24小时有效按压次数和抢救镇痛次数明显优于ICNB组(P<0.05)。然而,EB组的副作用发生率较高(P<0.05)。
结论:单孔胸腔镜肺手术后PVB和EB的镇痛效果优于ICNB。PVB引起的副作用和并发症较少,并且更安全,更有效。
OBJECTIVE: In this study, we compared the analgesic effects of intercostal nerve block (ICNB), ultrasound-guided paravertebral nerve block (PVB), and epidural block (EB) following single-port thoracoscopic lung surgery.
METHODS: A total of 120 patients who underwent single-hole thoracoscopic lung surgery were randomly and equally divided into three groups: ICNB group, the PVB group, and the EB group. ICNB was performed under direct thoracoscopic visualization before the conclusion of the surgery in the ICNB group, while PVB and EB were performed after general anesthesia in the PVB and EB groups, respectively. Patient-controlled intravenous analgesia (PCIA) was used following the surgery in all the groups. The following indicators were recorded: Intraoperative sufentanil dosage, anesthesia awakening time, postoperative intubation time, nerve block operation time, postoperative visual analog scale (VAS) pain scores during resting and coughing at regular intervals of 0, 2, 4, 8, 24, and 48 h, the time until first PCIA, number of effective compressions within 24 h postoperatively, number of rescue analgesia interventions, and the side effects.
RESULTS: In comparison to the ICNB group, the PVB and EB groups had a lower intraoperative sufentanil dosage, significantly shorter anesthesia awakening time, and postoperative intubation time, but longer nerve block operation time, lower VAS scores when resting and coughing within 24 h postoperatively (all p-values less than 0.05). Conversely, there were no statistically significant differences in VAS scores during resting and coughing after 24 h (all p-values greater than 0.05). Time to first PCIA, number of effective compressions and number of rescue analgesia at the 24-hour mark postoperatively were significantly better in the PVB and EB groups than that in the ICNB group (P < 0.05). However, there was a higher incidence of side effects observed in the EB group (P < 0.05).
CONCLUSIONS: The analgesic effect of PVB and EB following single-port thoracoscopic lung surgery is better than that of ICNB. PVB causes fewer side effects and complications and is safer and more effective.