A randomised trial of serratus anterior plane block for analgesia after thoracoscopic surgery

We evaluated the effect of pre‐operative serratus anterior plane block on postoperative pain and opioid consumption after thoracoscopic surgery. We randomly allocated 89 participants to block with 30 ml ropivacaine 0.375% (n = 44), or no block without placebo or sham procedure (n = 45). We analysed results from 42 participants in each group. Serratus anterior plane block reduced mean (SD) remifentanil dose during surgery, 0.12 (0.06) mg.h^?1 vs. 0.16 (0.06) mg.h^?1, p = 0.016, and reduced mean (SD) fentanyl consumption in the first 24 postoperative hours, 3.8 (1.9) μg.kg^?1 vs. 5.7 (1.6) μg.kg^?1, p = 0.000004. Block also reduced the worst median (IQR [range]) pain scores reported in the first 24 postoperative hours: 6 (5–7 [3–10]) vs. 7 (6–7 [3–10]), p = 0.027. Block decreased dissatisfaction with pain management, categorised as ‘highly unsatisfactory’, ‘unsatisfactory’, ‘neutral’, ‘satisfactory’ or ‘highly satisfactory’: 1/2/21/18/0 vs. 1/14/15/11/1, p = 0.0038. There were no differences in the rates of nausea, vomiting, dizziness or length of hospital stay. Serratus anterior plane block may be used to reduce pain and opioid use after thoracoscopic lung surgery.     

超声引导下前锯肌平面阻滞联合患者自控静脉镇痛对开腹肝部分切除术后早期康复的影响

目的 观察超声引导下前锯肌平面阻滞(SAPB)联合患者自控静脉镇痛(PCIA)在开腹肝部分切除手术后镇痛中的有效性和安全性,以及对患者早期康复的影响.方法 选择择期行开腹肝部分切除手术患者60例,男32例,女28例,年龄26～79岁,BMI 18～30 kg/m2,ASAⅠ—Ⅲ级.随机分为两组:SAPB联合PCIA组(...     

右美托咪定对罗哌卡因前锯肌平面阻滞半数有效浓度的影响

目的 探讨右美托咪定作为佐剂对罗哌卡因前锯肌平面阻滞(SAPB)半数有效浓度(EC₅₀)的影响。
方法 选择择期行胸腔镜下肺叶或肺段切除术患者44例,男26例,女18例,年龄40～64岁,BMI 18.5～24.0 kg/m²,ASA Ⅰ或Ⅱ级。随机分为两组:右美托咪定复合罗哌卡因组(DR组,n=21)和罗哌卡因组(R组,n=23)。两组均在超声引导下行SAPB,DR组注入含右美托咪定1.0 μg/kg的罗哌卡因混合溶液30 ml,R组注入罗哌卡因30 ml。罗哌卡因初始浓度为0.4％,按照序贯法确定下一例罗哌卡因浓度,相邻浓度比值为1.1。若上一例阻滞效果评定为良好,则下一例采用低1个等级的浓度,反之则采用高1个等级的浓度,获得7个上下交叉点后结束试验。采用Probit回归分析计算罗哌卡因的EC₅₀及其95％CI。记录神经阻滞前和神经阻滞后10、20、30 min的MAP、HR、麻醉趋势指数(NI)和Ramsay镇静评分。神经阻滞前以及神经阻滞后30 min,采用视觉模拟焦虑量表评估焦虑程度。记录神经阻滞后30 min内心动过缓、低血压、镇静过度、呼吸抑制、恶心呕吐、局麻药中毒、局部血肿、气胸等不良反应的发生情况。
结果 DR组和R组罗哌卡因EC₅₀分别为0.26％(95%CI 0.23％～0.28％)和0.32％(95%CI 0.30％～0.34％)。与R组比较,神经阻滞后30 min DR组MAP明显降低,HR明显减慢(P<0.05)。与R组比较,神经阻滞后20、30 min DR组NI明显降低,Ramsay镇静评分明显升高(P<0.05)。与R组比较,神经阻滞后30 min DR组视觉模拟焦虑评分明显降低(P<0.05)。两组均未发生严重不良反应。
结论 右美托咪定可降低罗哌卡因前锯肌平面阻滞的EC₅₀,提供有效的镇静和抗焦虑作用,较好地维持血流动力学的稳定。     

超声引导下前锯肌平面阻滞对乳房假体植入术后疼痛的影响

目的探讨超声引导下前锯肌平面(serratus anterior plane, SAP)阻滞对乳房假体植入术患者术后疼痛的影响。方法选择拟全麻下行双侧乳房假体植入术女性患者50例,年龄18～40岁,BMI 18～24 kg/m~2,ASAⅠ或Ⅱ级,随机分为神经阻滞组(N组)和对照组(C组),每组25例。在常规麻醉诱导前,N组行超声引导下双侧SAP阻滞,每侧注射0.375%罗哌卡因20 ml;C组每侧SAP注射生理盐水20 ml。记录患者术后2、6、12和24 h静息状态下VAS评分、围术期阿片类药物用量、PCIA泵有效按压次数、补救镇痛次数;记录不良反应发生情况和患者满意度。结果与C组比较,N组术后2、6、12和24 h VAS评分明显降低,术中瑞芬太尼用量和术后24 h内舒芬太尼用量明显降低,术后PCIA泵有效按压次数和补救镇痛次数明显减少,患者满意度明显提高(P0.05)。两组并发症发生率差异无统计学意义。结论超声引导下前锯肌平面阻滞可减轻乳房假体植入术患者术后疼痛。     

The role of serratus anterior plane and pectoral nerves blocks in cardiac surgery,thoracic surgery and trauma: a qualitative systematic review

Serratus anterior plane and pectoral nerves blocks are recently described alternatives to established regional anaesthesia techniques in cardiac surgery, thoracic surgery and trauma. We performed a systematic review to establish the current state of evidence for the analgesic role of these fascial plane blocks in these clinical settings. We identified relevant studies by searching multiple databases and trial registries from inception to June 2019. Study heterogeneity prevented meta-analysis and studies were instead qualitatively summarised and stratified by type of surgery and comparator. We identified 51 studies: nine randomised control trials; 13 cohort studies; 19 case series; and 10 case reports. The majority of randomised controlled trials studied the serratus anterior plane block in thoracotomy or video-assisted thoracoscopic surgery, with only two investigating pectoral nerves blocks. The evidence in thoracic trauma comprised only case series and reports. Results indicate that single-injection serratus anterior plane and the pectoral nerves blocks reduce pain scores and opioid consumption compared with systemic analgesia alone in cardiothoracic surgery, cardiac-related interventional procedures and chest trauma for approximately 6–12 h. The duration of action appears longer than intercostal nerve blocks but may be shorter than thoracic paravertebral blockade. Block duration may be prolonged by a continuous catheter technique with potentially similar results to thoracic epidural analgesia. There were no reported complications and the risk of haemodynamic instability appears to be low. The current evidence, though limited, supports the efficacy and safety of serratus anterior plane and the pectoral nerves blocks as analgesic options in cardiothoracic surgery.     

超声引导下低位前锯肌平面阻滞和腰方肌阻滞用于腹腔镜肾癌根治术的比较

目的比较超声引导下低位前锯肌平面阻滞(SAPB)和腰方肌阻滞(QLB)用于腹腔镜肾癌根治术的应用效果。方法选择行腹腔镜肾癌根治术患者90例,男55例,女35例,年龄18～80岁,BMI 19～28 kg/m~2,ASAⅠ或Ⅱ级。将患者随机分为三组:SAPB联合全麻组(S组)、QLB联合全麻组(Q组)和单纯全麻组(G组),每组30例。记录神经阻滞操作时间、神经阻滞起效时间、神经阻滞范围、神经阻滞相关并发症发生情况。记录术后0.5、2、12、24、48 h静息和活动时VAS疼痛评分。记录术中丙泊酚和瑞芬太尼用量、补救镇痛例数、术后48 h内镇痛泵按压次数及患者镇痛满意度评分。结果 S组阻滞操作时间和阻滞起效时间明显短于Q组(P0.05)。术后0.5、2、12、24 h S组和Q组静息和活动时VAS疼痛评分以及术后48 h活动时VAS疼痛评分明显低于G组(P0.05)。S组和Q组术中丙泊酚和瑞芬太尼用量明显少于G组(P0.05),补救镇痛率明显低于G组(P0.05),镇痛泵按压次数明显少于G组(P0.05),镇痛满意度评分明显高于G组(P0.05)。S组阻滞平面集中在T_6—T_(11),Q组阻滞平面集中在T_7—L_1。结论低位SAPB和QLB均可有效缓解腹腔镜肾癌根治术患者术后早期切口痛,减少术中全麻药物用量以及术后镇痛药物用量。与QLB比较,低位SAPB操作更简单、起效时间短,适宜在临床推广应用。     

前锯肌平面阻滞对胸腔镜手术患者术后急性疼痛和炎症反应的影响

目的 观察前锯肌平面阻滞(SAPB)对胸腔镜手术患者术后急性疼痛和炎症反应的影响.方法 选择2018年2月至2020年2月拟行胸腔镜手术患者104例,男64例,女40例,年龄26～64岁,BMI 18～24 kg/m2,ASAⅠ或Ⅱ级,采用随机数字表法将其分为两组,每组52例.S组采用全麻联合术前30 min行SAPB...     

超声引导下改良前锯肌平面阻滞对肝移植术患儿镇痛效果的影响

目的 观察经T6、T8水平入路的改良前锯肌平面阻滞(SAPB)对肝移植术患儿镇痛效果的影响。
方法 选择2019年1月至2020年12月择期行肝移植术患儿30例,男15例,女15例,年龄0～3岁,ASA Ⅲ或Ⅳ级。采用随机数字表法分为两组:全身麻醉联合改良SAPB组(S组)和全身麻醉组(C组),每组15例。气管插管后S组于双侧T6、T8水平行超声引导下改良SAPB,注入0.25％罗哌卡因1 ml/kg+地塞米松0.2 mg/kg,各注射点等量均分。两组麻醉诱导和麻醉维持方法一致。术后采用持续静脉泵注咪达唑仑2 μg·kg^-1·min^-1+瑞芬太尼3 μg·kg^-1·h^-1镇痛,并根据Comfort评分调整瑞芬太尼泵速。记录术中芬太尼及瑞芬太尼用量、术后瑞芬太尼用量及瑞芬太尼持续使用时间。于术后1、2、3、4、5、6 d检测总胆红素、白蛋白、AST、ALT浓度。记录ICU治疗时间、气管导管拔管时间以及术后肺部感染、肺不张的发生情况。
结果 与C组比较,S组术中、术后瑞芬太尼用量明显减少(P<0.05),术后瑞芬太尼持续使用时间明显缩短(P<0.05)。两组术中芬太尼用量差异无统计学意义。与术后1 d比较,S组术后2 d AST浓度和术后4 d总胆红素、ALT浓度明显降低(P<0.05);C组术后2 d AST浓度和术后3 d ALT浓度明显降低(P<0.05)。与C组比较,S组ICU治疗时间明显缩短(P<0.05)。两组气管导管拔管时间以及术后肺部感染、肺不张发生率差异无统计学意义。
结论 全身麻醉联合超声引导下改良前锯肌平面阻滞可以减少肝移植术患儿术中、术后镇痛药物用量,可为肝移植术患儿提供良好的围术期镇痛。     

A randomised controlled trial of pectoral nerve-2 (PECS 2) block vs. serratus plane block for chronic pain after mastectomy

Thoracic interfascial plane blocks are effective for post-mastectomy acute analgesia. However, their effects on chronic pain are uncertain. We randomly allocated 80 women equally to pectoral nerve-2 (PECS 2) block or serratus plane block. The pectoral nerve-2 block reduced the rate of moderate or severe chronic pain from 13/40 (33%) with the serratus plane block to 4/40 (10%), p = 0.03, adjusted odds ratio (95%CI) 0.23 (0.07–0.80), p = 0.02. The rates of pain-free women at six postoperative months were indeterminate, 10/40 (25%) after serratus plane block vs. 19/40 (48%) after pectoral nerve-2 block, p = 0.06, adjusted odds ratio (95%CI) 2.9 (1.1–7.5), p = 0.03. Health-related quality of life at six postoperative months was similar after serratus plane and pectoral nerve-2 blocks, mean (SD) EQ-5D-3L scores 0.87 (0.15) vs. 0.91 (0.14), respectively, p = 0.21. The pectoral nerve-2 block reduced median (IQR [range]) morphine consumption in the first 24 postoperative hours from 6 (3–9 [1–25]) mg to 4 (2–7 [0–37]) mg, p = 0.04. However, acute pain scores after serratus plane and pectoral nerve-2 blocks were similar, median (IQR [range]) 23 (11–35 [0–70]) mm vs. 18 (11–27 [0–61]) mm, respectively, p = 0.44. Pectoral nerve-2 block reduced chronic pain 6 months after mastectomy compared with serratus plane block.     

超声引导下前锯肌平面阻滞对开腹肝癌切除术围术期细胞免疫功能的影响

目的探讨超声引导下前锯肌平面阻滞(serratus anterior plane block, SAPB)对经肋缘下开腹肝癌切除术患者围术期细胞免疫功能的影响。方法开腹肝癌切除术患者55例,男33例,女22例,年龄48～65岁,体重57～72 kg,ASAⅠ或Ⅱ级,采用随机数字表法分为两组:SAPB联合全麻组(S组,n=28)和单纯全麻组(D组,n=27)。S组患者于全麻诱导后行超声引导下右侧第8—11肋SAPB,将0.5%罗哌卡因5 ml从第8—11逐肋分别注入。D组诱导后于相同位置注射等量生理盐水。术中采用七氟醚吸入和瑞芬太尼静脉泵注维持麻醉,术中根据需要追加舒芬太尼,术后均行舒芬太尼PCIA。记录术中瑞芬太尼、舒芬太尼用量,术后0～24 h和0～48 h镇痛泵按压次数,分别在诱导时、术后1 h、24 h和48 h检测外周血干扰素γ(INF-γ)和IL-4的浓度,计算INF-γ/IL-4比值。结果与D组比较,S组术中瑞芬太尼[(1.92±0.47) mg vs (2.33±0.38)mg,P0.05]和舒芬太尼追加次数明显减少,术后0～24 h和0～48 h镇痛泵按压次数明显减少(P0.05),术后INF-γ浓度[1 h:(5.42±0.80)pg/ml vs (4.11±0.79)pg/ml, 24 h:(4.23±0.90)pg/ml vs (3.88±0.62)pg/ml, 48 h:(4.42±0.85)pg/ml vs (3.79±0.83)pg/ml, P均0.05]和INF-γ/IL-4比值明显升高(1 h:2.19±0.44 vs 1.62±0.71, 24 h:1.67±0.48 vs 1.35±0.42, 48 h:1.77±0.63 vs 1.58±0.60,P均0.05)。结论超声引导下前锯肌阻滞可能有助于减轻肋缘下开腹肝癌切除术患者围术期的免疫抑制反应。     

超声引导下前锯肌平面阻滞对老年患者胸腔镜肺叶切除术后心肌酶和肌钙蛋白T的影响

目的 观察超声引导下前锯肌平面阻滞（SAPB）对老年患者胸腔镜肺叶切除术后心肌酶和肌钙蛋白T（cTnT）的影响。
方法 拟行胸腔镜肺叶切除术的老年患者60例,男24例,女36例,年龄65~78岁,BMI 19~26 kg/m²,ASA Ⅱ或Ⅲ级,随机分为两组：SAPB组（A组）和对照组（G组）,每组30例。A组全身麻醉诱导后行超声引导下SAPB,注入0.375%罗哌卡因20 ml。两组术中均行丙泊酚、瑞芬太尼静脉麻醉。记录术中阿片类药物用量,麻醉诱导前、术毕、术后6、24、48 h的MAP、HR、CVP,同时抽取外周静脉血检测心肌酶和cTnT,包括磷酸肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、乳酸脱氢酶（LDH）,并评估术后6、24、48 h静息和咳嗽时VAS评分,记录术后48 h内PCIA给药总量、有效按压次数和补救镇痛次数。
结果 术后24 h内A组HR明显慢于、MAP明显低于G组（P＜0.05）。术后24 h内A组静息与咳嗽时VAS评分明显低于G组,术后48 h内PCIA给药总量、有效按压次数和补救镇痛次数均明显低于G组（P＜0.05）。与麻醉诱导前比较,术后6、24、48 h两组cTnT,术毕、术后6、24、48 h两组CK,术后6、24 h两组CK-MB和术毕、术后6、24 h LDH均明显升高（P＜0.05）。术后6、24、48 h,A组cTnT明显低于G组（P＜0.05）。
结论 超声引导下SAPB联合全麻有助于降低胸腔镜肺叶切除术老年患者术后肌钙蛋白T水平,起到一定的心肌保护作用。     

Quality of recovery scores in deep serratus anterior plane block vs. sham block in ambulatory breast cancer surgery: a randomised controlled trial

Deep serratus anterior plane block has been widely adopted as an analgesic adjunct for patients undergoing breast surgery, but robust supporting evidence of efficacy is lacking. We randomly allocated 40 patients undergoing simple or partial mastectomy with sentinel node biopsy to receive either a pre-operative deep serratus anterior plane block (serratus group) or a placebo injection (sham group), in addition to systemic analgesia. The primary outcome measure was the quality of recovery score at discharge, as assessed by the quality of recovery-15 questionnaire at various time-points. Secondary analgesic outcomes included: pain severity; postoperative opioid consumption; opioid-related side-effects; patient satisfaction up to 7 days postoperatively; and persistent postoperative pain up to 3 months after surgery. All patients who were recruited completed the study. There were no differences in the quality of recovery-15 scores between patients in the serratus and control groups, with mean (SD) scores of 96 (14) and 102 (20) for the control and serratus groups, respectively. We were also unable to detect differences in any of the secondary analgesic outcomes examined. The addition of a deep serratus anterior plane block to systemic analgesia does not enhance quality of recovery in patients undergoing ambulatory breast cancer surgery.     

连续前锯肌平面阻滞对胸腔镜下肺癌根治术患者术后肺氧合功能的影响

目的比较连续前锯肌平面阻滞(SAPB)和静脉自控镇痛(PCIA)两种镇痛方式在胸腔镜下肺癌根治术患者术后减少肺部并发症、改善肺氧合功能方面的有效性。方法择期行胸腔镜下肺癌根治术患者126例,年龄18～70岁,BMI 18.5～30.0 kg/m~2,ASAⅠ–Ⅲ级,随机分为两组:连续SAPB组(S组)和PCIA组(P组),每组63例。术毕S组行超声引导下前锯肌平面阻滞,注入0.375%罗哌卡因20 ml,留置导管予0.2%罗哌卡因行自控镇痛;P组行舒芬太尼常规PCIA。麻醉诱导前(T_0)、术毕即刻(T_1)、拔管后2 h(T_2)、拔管后6 h(T_3)、拔管后24 h(T_4)抽取桡动脉血记录PaO_2并计算氧合指数(OI)。记录T_2—T_4时静态和活动VAS评分,并记录肺部并发症发生情况。结果与T_0时比较,T_2、T_3时两组OI明显降低,且P组明显低于S组(P0.05)。T_2—T_4时S组VAS评分明显低于P组(P0.05),但两组补救镇痛例数差异无统计学意义。与P组比较,S组低氧血症、肺不张、恶心、呕吐的发生率明显降低(P0.05)。结论连续SAPB较PCIA能够改善胸腔镜下肺癌根治术患者肺氧合功能。     

超声引导下低位前锯肌平面阻滞对上腹部手术患者术后镇痛及炎症反应的影响

目的 评价超声引导下低位前锯肌平面阻滞(SAPB)对上腹部手术患者术后镇痛及炎症反应的影响.方法 择期上腹部手术患者120例,男69例,女51例,年龄18～65岁,ASAⅠ或Ⅱ级.随机分为三组:对照组(C组,n=39),不行神经阻滞;常规SAPB组(SAPB组,n=40),全麻诱导前超声引导下双侧腋中线第5肋水平前锯肌...     

前锯肌平面阻滞对心肺转流下胸腔镜心脏手术患者应激反应和术后镇痛的影响

目的 探讨前锯肌平面阻滞(SAPB)对心肺转流(CPB)下胸腔镜心脏手术患者应激反应和术后镇痛的影响。方法 选择2018年1月至2019年3月行CPB下胸腔镜心脏手术患者40例,男25例,女15例,年龄18～64岁,BMI 18～28 kg/m²,ASAⅢ级。采用随机数字表法分为两组：SAPB组(S组)和对照组(C组),每组20例。S组于麻醉诱导前行超声引导下SAPB,在前锯肌表面缓慢注射0.5%罗哌卡因20 ml, 30 min后测定阻滞效果,满意后实施全凭静脉麻醉。C组不做处理。两组采用相同的全凭静脉麻醉方法,术毕均行静脉自控镇痛。分别于麻醉诱导前(T₁)、CPB前(T₂)、CPB结束时(T₃)、手术结束时(T₄)、手术结束后24 h(T₅)抽取静脉血,测血浆皮质醇(Cor)、肾上腺素(E)、血糖(Glu)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)的浓度。记录术中及术后24 h舒芬太尼的用量、苏醒时间、气管拔管时间、心胸外科重症监护室...     

超声引导下前锯肌平面阻滞对乳腺癌患者术后镇痛的影响

目的探讨超声引导下前锯肌平面(serratus plane, SP)阻滞对乳腺癌患者术后急性疼痛和细胞免疫功能的影响。方法选择2016年1月至2018年6月在本院行择期乳腺癌改良根治术女性患者60例,年龄40～65岁,BMI 20.1～24.5 kg/m~2,ASAⅠ或Ⅱ级。采用随机数字表法随机分为两组:SP阻滞联合全身麻醉组(S组)和全身麻醉组(N组),每组30例。两组均采用气管插管静脉全身麻醉,S组在麻醉诱导后在超声引导下行患侧SP阻滞,注射0.3%罗哌卡因25 ml。N组不行SP阻滞。术后两组均行舒芬太尼PCIA。记录术后舒芬太尼用量、术后首次按压镇痛泵时间和48 h内镇痛泵有效按压次数。记录麻醉诱导前、术毕、术后24和48 h NK细胞、NKT细胞、调节性T细胞百分比。记录术后48 h内不良反应的发生情况。结果与N组比较,S组术后舒芬太尼用量明显减少(P0.05),术后首次按压时间明显延长(P0.05),术后48 h内镇痛泵有效按压次数明显减少(P0.05)。与麻醉诱导前比较,术毕、术后24、48 h N组NK细胞、NKT细胞百分比明显降低,调节性T细胞百分比明显升高(P0.05)。与N组比较,术毕、术后24、48 h S组NK细胞、NKT细胞百分比明显升高,调节性T细胞百分比明显降低(P0.05)。两组术后48 h内均无一例不良反应。结论乳腺癌手术患者实施超声引导下前锯肌平面阻滞能明显缓解术后急性疼痛,减少围术期镇静镇痛药使用并减轻免疫抑制程度。     

超声引导下低位前锯肌平面阻滞对经皮肾镜取石术后镇痛的影响

目的 评价超声引导下低位前锯肌平面阻滞对经皮肾镜取石术患者术后镇痛效果的影响.方法 选择择期全麻下行经皮肾镜取石术患者60例,男38例,女22例,年龄22～64岁,BMI 18～26 kg/m2,ASAⅠ或Ⅱ级.采用随机数字表法分为两组:全身麻醉组(C组)和全身麻醉联合低位前锯肌平面阻滞组(T组),每组30例.T组在超...     

Surgical management of children with pyopneumothorax: serratus anterior digitation flap

Spontaneous bronchopleural fistula after childhood empyema remains a surgically challenging condition to treat and is associated with a high morbidity. Four children with pyopneumothorax and associated spontaneous infective bronchopleural fistula are reported. Drainage of the empyema by thoracotomy was performed together with limited decortication and the suturing of a raised digitation of serratus anterior around the fistula to achieve a successful outcome. The surgical technique of raising a serratus anterior digitation flap is described.     

胸椎旁神经阻滞联合前锯肌平面阻滞对全麻下胃癌根治术患者术后早期康复的影响

目的:观察胸椎旁神经阻滞（thoracic paravertebral nerve block, TPVB）联合前锯肌平面阻滞（serratus anterior plan block, SAPB）对全麻下胃癌根治术患者术后早期康复的影响。方法:择期行腹腔镜胃癌根治术的患者60例,按随机数字表法分为两组：单纯全麻组（G...