关键词: 麻醉,局部, 胸腔镜检查, 疼痛,手术后, 竖脊肌平面阻滞, 胸椎旁阻滞, 恢复质量

Abstract:

Objective To observe the effect of thoracic paravertebral block (TPVB) combined with erector spinae plane block (ESPB) on postoperative analgesia and quality of recovery in patients underwent video-assisted thoracic surgery. Methods Ninety patients underwent video-assisted thoracic surgery were selected and randomly divided into the E group, the T group and the TE group (preoperatively receiving ultrasound-guided ESPB, TPVB and TPVB+ESPB, respectively), with 30 patients in each group. In the three groups, 0.5% ropivacaine 25 mL was used as local anesthetic. In the TE group, TPVB combined with ESPB was executed, and 5 and 20 mL local anesthetics were used successively. Patient-controlled intravenous analgesia (PCIA) was used as a rescue analgesia postoperatively. Data of hypesthesia at lateral chest wall at 30 min after completion of block, intraoperative incidence of hypotension and dosage of anesthetics were recorded. Patients were followed up for Numeric Rating Scales (NRS) score, time to first rescue analgesia, number of rescue analgesia, quality of recovery-15 score, analgesia satisfaction score, postoperative nausea and vomiting (PONV) scores in the first 24 h post-surgery and incidence of postoperative chronic pain at 6 months. Results The incidence of preoperative hypesthesia was higher in the TE group and the T group than that in the E group (P<0.05). The intraoperative use of remifentanil was lower in the T group than that of the E group and the TE group, but the utilization rate of vasoconstricting drugs was the highest (P<0.05). NRS scores at rest and coughing were lower in the T group than those in the E and TE groups (P<0.05). There were no significant differences in the time to first rescue analgesia and the number of rescue analgesia between the three groups (P>0.05). Compared with the E group, the T group had a better postoperative QoR-15 scores (P<0.05), and the group TE had lower incidence of postoperative chronic pain (P<0.05). There were no statistical differences in analgesia satisfaction scores and PONV scores between the three groups (P>0.05). Conclusion The effects of TPVB+ESPB on postoperative analgesia and quality of recovery in patients underwent thoracoscopic surgery are not better than those of ESPB and TPVB, but it has a faster onset time of sensory block than ESPB and reduces the occurrence of postoperative chronic pain.

Key words: anesthesia, local, thoracoscopy, pain, postoperative, erector spinae plane block, thoracic paravertebral block, quality of recovery