双侧竖脊肌平面阻滞复合静脉镇痛对胃癌手术患者术后早期康复的影响

目的 探讨双侧竖脊肌平面阻滞复合静脉镇痛对胃癌手术患者术后早期康复的影响。 方法 选择择期行腹腔镜胃癌根治术患者60例，美国麻醉医师协会（American Society of Anesthesiologists,ASA）Ⅰ或Ⅱ级，随机分为阻滞组（B组）和硬膜外组（E组），每组30例。两组均接受静脉全身麻醉，在麻醉诱导实施前B组行超声引导下双侧竖脊肌平面阻滞，E组行硬膜外穿刺置管。B组术后行静脉自控镇痛，E组行硬膜外自控镇痛。记录术后2、4、8、12、24、48 h的静息疼痛（visual analogue scale,VAS）评分，记录氟比洛芬酯补救性镇痛例数、术后排气时间、首次进食时间、首次下床活动时间、住院时间和镇痛满意度评分，记录术后48 h内镇痛相关不良反应，包括恶心呕吐、皮肤瘙痒、眩晕、呼吸抑制、尿潴留等。 结果 2组术后静息疼痛VAS评分随术后时间越来越高（P＜0.05），组间、组间和时点间交互作用差异无统计学意义（P＞0.05）。B组补救性镇痛例数为1例（3.3%），E组2例（6.7%），两组差异无统计学意义（χ2=0.000，P=1.000）。B组术后排气时间、进食时间、首次下床活动时间及住院时间均短于E组（P＜0.05），镇痛满意度明显高于E组（P＜0.05）；术后48 h内镇痛相关不良反应发生率明显低于E组（P＜0.05）。 结论 双侧竖脊肌平面阻滞复合静脉镇痛与连续硬膜外镇痛均能为胃癌手术患者提供良好术后镇痛，但前者不良反应更少，患者满意度更高，更有利于患者早期快速康复，缩短住院时间。

Effects of bilateral erector spinae plane block combined with intravenous analgesia on early postoperative rehabilitation in patients undergoing gastric cancer surgery

Objective To investigate the effect of bilateral erector spinae plane block(ESPB) on early postoperative rehabilitation of patients with gastric cancer after comparison with continuous epidural analgesia.Methods A total of 60 patients undergoing elective laparoscopic radical gastrectomy were randomly divided into block group(group B, n=30) and epidural group(group E, n=30). They were American Society of Anesthesiologists(ASA) grade Ⅰ or Ⅱ. Both groups received general anesthesia. Before anesthesia induction, group B underwent bilateral ESPB under ultrasound guidance, and group E was treated with epidural puncture. After operation, group B was treated with patient-controlled intravenous analgesia and group E was treated with patient-controlled epidural analgesia. The visual analogue scale(VAS) score of resting pain at 2, 4, 8, 12, 24 and 48 h after operation was recorded. The number of cases of remedial analgesia with flurbiprofen axetil, postoperative exhaust time, first time of food intake, first time of off-bed activity, length of hospitalization and analgesic satisfaction score were recorded. The analgesia-related adverse reactions within 48 h after operation were recorded, including nausea and vomiting, skin itching, dizziness, respiratory depression, and urinary retention.Results The resting pain VAS scores of the two groups got higher and higher with the postoperative time(P＜0.05). There was no significant difference in the interaction between groups, groups and time points(P＞0.05) .The number of salvage analgesia in group B was 1 case(3.3%), and there were 2 cases in group E(6.7%). The difference between the two groups was not statistically significant(χ2=0.000, P=1.000).The postoperative exhaust time, first time of food intake, first time of off-bed activity and length of hospitalization of group B were shorter than those of group E(P＜0.05), while the satisfaction of analgesia was significantly higher than that of group E(P＜0.05), and the incidence of analgesia-related adverse reactions within 48 h after operation was significantly lower than that of group E(P＜0.05).Conclusion Bilateral ESPB combined with intravenous analgesia or continuous epidural analgesia can provide good postoperative analgesia for patients receiving gastric cancer surgery, but the former has fewer adverse reactions and higher patient satisfaction, which is more conducive to early rapid rehabilitation and shorter hospital stay.