超声引导下单次竖脊肌平面阻滞与硬膜外自控镇痛在老年患者胸腔镜手术中的应用

Abstract
Figure/Table
References
Related Citation (15)

Download: PDF (736 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective To evaluate the effect of ultrasound-guided erector spine plane block and patient-controlled epidural analgesia on postoperative analgesia in elderly patients undergoing thoracoscopic surgery.Methods Seventy elderly patients (38 males and 32 females, aged 62 to 78, BMI 20.3-24.5 kg/m², ASA Ⅰ or Ⅱ) undergoing elective thoracoscopic surgery between May 2018 and May 2019 were enrolled. These patients were evenly divided into two groups: the ESP group and PCEA group using random number table method. In the ESP group, single spinal plane block was performed at the level of thoracic 5 (T₅). 0.5% ropivacaine 0.5 ml/kg was given after the erector plane was determined by ultrasound. In the PCEA group, epidural block was performed before and after the experimental dose was given. No continuous epidural block was given during surgical procedures. Morphine was epidurally injected at the loading dose 30 minutes before the end of operation and PCEA was used as postoperative analgesia. General anesthesia was routinely induced and maintained in both groups. VAS and BCS scores were recorded at 1, 4, 12, 24 and 48 h postoperatively. The scores of satisfaction of patients with postoperative analgesia were recorded. Such adverse reactions as dizziness, cough weakness and chest tightness and such complications as headache, pneumothorax, local anesthetic poisoning, visceral injury and general spinal anesthesia were recorded.Results Compared with the PCEA group, there was no significant difference in VAS scores or BCS score in the ESP group at postoperative 1, 4, 12, 24 hours. VSA scores increased while BCS scores decreased at postoperative 48 hours (P<0.05) and the number of patients who needed additional tramadol was increased (P<0.05). The incidence of dizziness, cough weakness, chest tightness and headache in the ESP group were lower than in the PCEA group (P<0.05). There was statistical difference in satisfaction scores between the two groups. No pneumothorax, local anesthetic poisoning, visceral injury, general spinal anesthesia or other related complications was recorded in either group.Conclusions Ultrasound-guided single spine plane block is safe and effective for postoperative analgesia in elderly patients undergoing thoracoscopic surgery.

Key words： erector spine plane thoracoscopy patient controlled epidural analgesia elderly patients postoperative analgesia

Received: 21 April 2019

ZTFLH:

R614

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	ZHANG Hanping
	RUI Longjie
	and LI Dong

Cite this article:

ZHANG Hanping,RUI Longjie,and LI Dong. Effects of ultrasound-guided erector spine plane block and patient-controlled epidural analgesia on postoperative analgesia in elderly patients undergoing thoracoscopic surgery[J]. Med. J. Chin. Peop. Armed Poli. Forc., 2020, 31(1): 43-46.

URL:

http://journal08.magtechjournal.com/Jwk_wjyx/EN/ OR http://journal08.magtechjournal.com/Jwk_wjyx/EN/Y2020/V31/I1/43

[1]	Nagahiro I, Andou A, Aoe M, et al. Pulmonary function, postoperative pain, and serum cytokine level after lobectomy: a comparison of VATS and conventional procedure[J].Ann Thorac Surg, 2001, 72(2): 362-365.
[2]	张弘广. 单孔胸腔镜与多空胸腔镜肺癌手术的临床疗效比较[J].武警医学, 2018, 29 (1): 15-18.
[3]	梁大顺, 廖历兴, 曹金良, 等. 胸椎旁神经阻滞对肺癌根治术患者炎性反应和术后镇痛效果的影响[J].实用医学杂志, 2017, 33(18): 3051-3054.
[4]	Bouman E A C, Sieben J M, Balthasar A J R, et al. Boundaries of the thoracic paravertebral space: potential risks and benefits of the thoracic paravertebral block from an anatomical perspective[J].Surg Radiol Anat, 2017, 39(10): 1117-1125.
[5]	Li Y, Lu S, Ma S C, et al. Effects of patient controlled epidural analgesia and patient controlled intravenous analgesia on analgesia in patients undergoing spinal fusion surgery[J].Am J Ther, 2016, 23(6): e1806.
[6]	Lu S, Ma S C, Wang Y Y, et al. Comparison of pain relief between patient-controlled epidural analgesia and patient-controlled intravenous analgesia for patients undergoing spinal fusion surgeries[J].Arch Orthop Traum Su, 2015, 135(9): 1247-1255.
[7]	Chin K J, Malhas L, Perlas A. The erector spinae plane block provides visceral abdominal analgesia in bariatric burgery: a report of 3 cases[J].Region Anesth Pain M, 2017, 42(3): 372-376.
[8]	周桥灵, 徐枫, 李露君, 等. 不同剂量右美托咪定复合罗哌卡因腹横肌平面阻滞用于腹腔镜结肠癌手术镇痛[J].实用医学杂志, 2016, 32(24): 4108-4110.
[9]	周桥灵,刘洪珍,赖晓红,等.超声引导下单次竖脊肌平面阻滞用于老年患者术后镇痛的效果[J].临床麻醉学杂志, 2018, 34(11): 1080-1083.
[10]	赵尧平,于双,郑少强,等.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[J].临床麻醉学杂志, 2019,35(2):129-132.
[11]	Forero M, Adhikary S D, Lopez H, et al. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic Pain[J]. Region Anesth Pain M, 2016, 41(5): 621.
[12]	Tulgar S, Selvi O, Senturk O, et al. Clinical experiences of ultrasound-guided lumbar erector spinae plane block for hip joint and proximal femur surgeries[J].J Clin Anesth, 2018, 47(1): 5.

[1]	. [J]. Med. J. Chin. Peop. Armed Poli. Forc., 2019, 30(7): 623-624.