超声引导下前锯肌平面阻滞对胸腔镜下肺叶切除术患者术后镇痛的影响

目的 探讨超声引导下前锯肌平面阻滞 （SAPB） 对胸腔镜下肺叶切除术患者术后镇痛效果的影响。方法 60例择期全麻下行胸腔镜下肺叶切除术患者随机分为静脉自控镇痛组 （P组） 及静脉自控镇痛+SAPB组 （S组） 2组术毕均行吗啡静脉自控镇痛 （PCIA）， S组患者手术结束后立即行超声引导下术侧SAPB， 注射0.375%罗哌卡因 0.4 mL/kg。记录2组患者术后6 h、 12 h、 24 h内吗啡累积消耗量及术后30 min、 1 h 、 2 h、 6 h、 12 h、 24 h NRS疼痛评分若NRS疼痛评分大于4分， 静脉注射氟比洛芬酯50 mg， 必要时可重复， 并记录镇痛补救比例、 术后RASS镇静评分以及恶心呕吐、 瘙痒、 呼吸抑制、 心动过缓、 低血压等不良反应发生情况。结果 S组术后30 min、 1 h 、 2 h、 6 h NRS疼痛评分明显低于P组 （P＜0.01）， 2组术后12 h及24 h NRS疼痛评分差异无统计学意义； 2组NRS疼痛评分均随着术后时间的延长逐渐降低， 处理因素与时间因素不存在交互作用 （P＞0.05）； S组术后6、 12、 24 h内吗啡累积消耗量均明显低于P组 （P＜0.01）； 2组不良反应发生率， 以及组间的RASS镇静评分， 镇痛补救比例差异无统计学意义。结论 超声引导下SAPB能明显减少胸腔镜下肺叶切除术患者术后吗啡消耗量及减轻术后早期疼痛， 且不增加不良反应。

Effects of ultrasound-guided SAPB (serratus anterior plane block) on postoperative analgesia in patients undergoing thoracoscopic lobectomy

Objective To investigate the effect of ultrasound-guided serratus anterior plane block (SAPB) on postoperative analgesia in patients undergoing thoracoscopic lobectomy. Methods Sixty patients scheduled for thoracoscopic lobectomy under general anesthesia were randomly divided into two groups, group P (intravenous patient- controlled analgesia) and group S (intravenous patient-controlled analgesia+SAPB). Patients received morphine intravenous patient-controlled analgesia (PCIA) after operation in the two groups. Patients of group S were given ultrasound-guided SAPB with 0.4 mL/kg of either 0.375% ropivacaine after the operation immediately. Morphine cumulative consumption at the 6th, 12th and 24th postoperative hours and NRS (numerical rating scale) pain scores at the 30 min, 1, 2, 6, 12 and 24 postoperative hours were recorded respectively in both two groups. Flurbiprofen axetil 50 mg was injected intravenously when the NRS pain score was greater than 4, and it could be repeated if necessary. Adverse reactions such as analgesic rescue cases, postoperative RASS sedation score and nausea, vomiting, pruritus, respiratory depression, bradycardia and hypotension were recorded. Results The NRS pain scores at the 30 min and 1, 2, 6 h were significantly lower in group S than those in group P (P＜0.01). There were no significant differences in NRS pain scores at 12 and 24 h after operation between two groups. NRS pain scores were gradually reduced with the prolongation of postoperative time in two groups. There was no interaction between groups and processing times (P＞0.05). Morphine cumulative consumption were significantly lower at 6, 12 and 24 postoperative hours in group S than those in group P (P＜0.01). No significant differences were found in the incidence of adverse reactions, RASS sedation scores and analgesic rescue cases between two groups. Conclusion Ultrasound-guided SAPB can significantly reduce postoperative morphine consumption and early pain scores in patients undergoing thoracoscopic lobectomy, without increasing the incidence of adverse reactions.