超声引导下竖脊肌平面阻滞在慢性脓胸患者术中及术后镇痛中的效果

摘要

Objective To observe the efficacy of ultrasound-guided erector spinae plane (ESP) block on intraoperative and postoperative analgesia in patients undergoing chronic empyema. Methods Sixty patients scheduled for elective decortication of pleural fibreboard under video-assisted thoracoscopic, 35 males and 25 females, aged 30-70 years, falling into ASA physical status Ⅰ or Ⅱ, were randomized into 2 groups: ESP block combined with general anesthesia group (group E) and only general anesthesia group (group G). Patients in group E received ESP block before general anesthesia, while patients in group G received general anesthesia only. All patients received patient controlled intravenous analgesia (PCIA). The thoracic paravertebral space were recorded using ultrasound. Dermatomes of sensory block on midclavicular line were recorded at 20 min after ESP block. The amount of remifentanil, duration of stay in post-anesthesia care unit, the frequency of PCIA pressing, the pain analog scale (VAS) scores during rest and movement at 1, 4, 12, 24, 48 h after operation were recorded. Results Twenty-four patients in group E showed unclear thoracic paravertebral space, dermatomes of sensory block at 20 min after ESP block were 4.9 ± 1.0 on midclavicular line. The consumption of remifentanil and duration of stay in post-anesthesia care unit and the frequency of PCIA pressing in group E were significantly less than that in group G (P ＜ 0.05). The VAS scores at 1, 4, 12, 24 h in group E were lower than those of group G (P ＜ 0.05). Conclusion The ultrasound-guided erector spinae plane block were safe and effective for patients undergoing chronic empyema, and provided satisfactory intraoperative and postoperative analgesia.%目的 观察超声引导下竖脊肌平面(erector spinae plane,ESP)阻滞对慢性脓胸患者术中及术后镇痛效果的影响.方法 择期行胸腔镜下胸膜纤维板剥脱术的慢性脓胸患者60例,男35例,女25例,年龄30～70岁,ASAⅠ或Ⅱ级,随机分为两组:ESP阻滞复合全身麻醉组(E组)和单纯全身麻醉组(G组).两组均行全身麻醉,E组全身麻醉前实施超声引导下ESP阻滞,术毕均采用患者自控静脉镇痛(patient controlled intravenous analgesia,PCIA).记录E组超声下胸椎旁间隙显示情况,ESP阻滞20 min后在锁中线处感觉阻滞范围;记录两组术中瑞芬太尼用量、PACU停留时间、术后PCIA泵有效按压次数、术后1、4、12、24、48 h静息和活动时VAS评分.结果 E组有24例胸椎旁间隙显示不清,ESP阻滞20 min后感觉阻滞节段为4.9±1.0.E组术中瑞芬太尼用量和术后PCIA泵有效按压次数明显少于G组(P＜0.05),PACU停留时间明显短于G组(P＜0.05),术后1、4、12、24 h静息和活动时VAS评分明显低于G组(P＜0.05).结论 超声引导下ESP阻滞对慢性脓胸患者是一种安全的镇痛方法,能够提供有效的术中及术后镇痛.