超声引导胸椎旁神经阻滞和前锯肌阻滞用于保留自主呼吸胸腔镜手术的比较

目的: 比较超声引导胸椎旁神经阻滞(thoracic paravertebral block,TPVB)和前锯肌阻滞(serratus plane block,SPB)对保留自主呼吸全身麻醉胸腔镜手术的影响。方法: 择期拟行胸腔镜手术患者60例，性别不限，年龄18~65岁，体重指数18~24 kg/m2，ASA分级Ⅰ~Ⅱ级，随机分为TPVB组和SPB组；两组分别在麻醉诱导前超声引导下行0.375%的罗哌卡因20 mL TPVB或SPB，全凭静脉麻醉诱导置入喉罩；记录患者麻醉诱导前(T0)、麻醉诱导后自主呼吸恢复时(T1)、手术开始30 min时(T2)、手术开始60 min时(T3)、手术结束时(T4)及苏醒时(T5)平均动脉血压、心率、动脉血氧饱和度及呼气末二氧化碳分压；记录患者术后2、4、6、12、24和48 h静息及咳嗽时视觉模拟评分(visual analog score, VAS)，术后有效镇痛泵按压次数，阿片类药物累计使用量；记录患者神经阻滞持续时间及并发症情况。结果： 两组患者T0、T1、T2、T3、T4和T5时平均动脉血压、心率、动脉血氧饱和度及呼气末二氧化碳分压比较，差异均无统计学意义；SPB组神经阻滞时间明显长于TPVB组(P<0.05)，术后6 h、12 h咳嗽时VAS低于TPVB组(P<0.05)，术后有效镇痛泵按压次数及阿片类药物累计使用量低于TPVB组(P<0.05)。结论： 超声引导下TPVB和SPB均能安全、有效地用于保留自主呼吸全身麻醉下胸腔镜手术，但SPB能明显延长术后镇痛时间、减少阿片类药物总用量。

Comparison of the effects of ultrasound-guided thoracic paravertebral nerve block and serratus plane block on thoracoscopic surgery undergeneral anesthesia with spontaneous breathing

Objective: To compare the effects of ultrasound-guided thoracic paravertebral nerve block(TPVB) and serratus plane block(SPB) on thoracoscopic surgery under general anesthesia with spontaneous breathing. Methods: Sixty patients aged 18~65 years, with BMI between 18~24 kg/m2 and ASA physical status Ior II, undergoing thoracoscopic surgery were selected. They were divided randomly into two groups: TPVB group and SPB group; both groups underwent ultrasound guided TPVB or SPB with 0.375% ropivacaine 20 mL before induction of anesthesia; the laryngeal mask was placed after intravenous anesthesia. Blood pressure, heart rate, arterial blood oxygen saturation (SaO2), end-tidal carbon dioxide partial pressure (PetCO₂) were recorded before induction of anesthesia (T0), when spontaneous breathing was recoveried after anesthesia induction(T1), 30(T2) and 60(T3) minutes after onset of surgery, at the end of surgery(T4), and after recovery(T5). Visual analog scale(VAS) scores at rest and cough were recorded at different time-points: 2,4,6,12,24 and 48 h after surgery. The number of effective compressions for patient -controlled analgesia and the cumulative dosage of opioids drugs, duration of block and complications were recorded. Results: There were no significant differences in blood pressure, heart rate, SaO₂ and PetCO₂ among T0, T1, T2, T3, T4 and T5 between TPVB group and SPB group. The time of the sensory block was significantly longer in the SPB group than that of the TPVB group(P<0.05). The VAS at cough was lower than the TPVB group at 6 h, 12 h after surgery(P<0.05). The number of effective compressions for patient -controlled analgesia and the cumulative dosage of opioids drugs was lower in the SPB group than that of the TPVB group(P<0.05). Conclusion: Ultrasound-guided TPVB and SPB could be safe and effective for the thoracoscopic surgery under general anesthesia with spontaneous breathing. However, SPB could significantly prolong postoperative analgesia, reduce the total amount of opioids administration.［Key words］ultrasound; thoracic paravertebral nerve block; serratus plane block; thoracoscopic surgery