Effects of erector spinae plane block with different concentrations of ropivacaine in patients with thoracoscopic lobectomy

doi:10.11958/20252134

Abstract

Abstract:

Objective To investigate the effects of different concentrations of ropivacaine in erector spinae plane block (ESPB) on postoperative pain and stress response in patients undergoing thoracoscopic lobectomy, and to evaluate their impact on postoperative pulmonary function and early recovery. Methods A total of 114 patients scheduled for thoracoscopic lobectomy were finally included and were randomly divided into the group A (0.375% ropivacaine, 57 cases) and the group B (0.5% ropivacaine, 57 cases) using a random number table method. Intraoperative surgical indicators were recorded, and postoperative patient-controlled intravenous analgesia (PCIA) usage was monitored in the two groups of patients. Pain intensity was assessed using the Visual Analog Scale (VAS) at 2, 6, 12, 24 and 48 hours postoperatively. Stress markers [adrenocorticotropic hormone (ACTH), norepinephrine (NE) and cortisol (Cor)] were measured preoperatively and at 6, 24 and 48 hours postoperatively. Pulmonary function parameters [forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁) and FEV₁/FVC ratio] were evaluated one week after surgery. Recovery time, post-anesthesia care unit (PACU) stay duration and perioperative adverse event rates were also recorded. Results Compared with the group A, the group B exhibited a longer time to first PCIA demand and fewer PCIA presses within 48 hours (P<0.05). VAS scores increased at 12, 24 and 48 hours compared to 2 hours postoperatively in both groups (P<0.05), but the VAS scores of pain were significantly lower at 24 and 48 hours after surgery in the group B than those of the group A (P<0.05). ACTH, NE and Cor levels increased at 6, 24 and 48 hours postoperatively (P<0.05), but each time point index was lower in the group B than that of the group A (P<0.05). Compared with preoperative values, the FVC, FEV₁ and FEV₁/FVC levels were increased one week after surgery in both groups (P<0.05), but there were no significant differences between the two groups (P>0.05). The recovery time and the PACU stay time were significantly longer in the group B than those of the group A (P<0.05). There were no significant differences in perioperative adverse event rates between the two groups (14.04% vs. 22.81%, P>0.05). Conclusion The 0.5% ropivacaine ESPB can better alleviate pain and stress response of patients undergoing thoracoscopic lobectomy beyond 24 hours postoperatively, whereas 0.375% ropivacaine facilitates earlier recovery. Both concentrations demonstrate good safety, and clinical selection should be individualized.

Key words: ropivacaine, thoracoscopy, pneumonectomy, anesthesia, local, analgesia, erector spinae

CLC Number:

R971.2，R655.3

Figures/Tables 7

References 22

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组别	n	性别（男/女）	年龄/ 岁	体质量指数/（kg/m²）		ASA分级
组别	n	性别（男/女）	年龄/ 岁	体质量指数/（kg/m²）		Ⅰ级	Ⅱ级
A组	57	32/25	53.95±5.26	22.65±1.35		21（36.8）	36（63.2）
B组	57	35/22	54.36±5.17	22.73±1.44		24（42.1）	33（57.9）
χ²或t		0.326	0.420	0.306		0.330
组别		疾病类型			切除范围
组别		早期非小细胞肺癌		多发性肺结节	单侧肺叶	双侧肺叶	楔形
A组		44（77.2）		13（22.8）	40（70.2）	5（8.8）	12（21.0）
B组		40（70.2）		17（29.8）	42（73.7）	6（10.5）	9（15.8）
χ²		0.724			0.568

组别	n	性别（男/女）	年龄/ 岁	体质量指数/（kg/m²）		ASA分级
组别	n	性别（男/女）	年龄/ 岁	体质量指数/（kg/m²）		Ⅰ级	Ⅱ级
A组	57	32/25	53.95±5.26	22.65±1.35		21（36.8）	36（63.2）
B组	57	35/22	54.36±5.17	22.73±1.44		24（42.1）	33（57.9）
χ²或t		0.326	0.420	0.306		0.330
组别		疾病类型			切除范围
组别		早期非小细胞肺癌		多发性肺结节	单侧肺叶	双侧肺叶	楔形
A组		44（77.2）		13（22.8）	40（70.2）	5（8.8）	12（21.0）
B组		40（70.2）		17（29.8）	42（73.7）	6（10.5）	9（15.8）
χ²		0.724			0.568

组别	麻醉时间/min		手术时间/min		术中出血量/mL		术中丙泊酚用量/mg
A组	151.46±37.54		88.95±25.33		108.26±19.59		831.06±15.43
B组	155.23±40.59		89.46±22.77		110.51±20.09		835.49±17.59
t	0.515		0.113		0.604		1.432
组别		术中瑞芬太尼用量/mg		术后PCIA首次按压时间/h		48 h内PCIA按压次数/次
A组		0.98±0.26		10.46±2.76		6.56±2.16
B组		1.07±0.35		12.33±3.02		4.95±1.34
t		1.401		3.461^＊＊		4.787^＊＊

组别	麻醉时间/min		手术时间/min		术中出血量/mL		术中丙泊酚用量/mg
A组	151.46±37.54		88.95±25.33		108.26±19.59		831.06±15.43
B组	155.23±40.59		89.46±22.77		110.51±20.09		835.49±17.59
t	0.515		0.113		0.604		1.432
组别		术中瑞芬太尼用量/mg		术后PCIA首次按压时间/h		48 h内PCIA按压次数/次
A组		0.98±0.26		10.46±2.76		6.56±2.16
B组		1.07±0.35		12.33±3.02		4.95±1.34
t		1.401		3.461^＊＊		4.787^＊＊

组别	术后2 h	术后6 h	术后12 h	术后24 h	术后48 h
A组	1.42±0.50	1.68±0.51^a	2.05±0.58^ab	2.46±0.71^abc	2.89±0.56^abcd
B组	1.39±0.50	1.53±0.57	1.86±0.61^ab	2.18±0.63^abc	2.54±0.60^abcd
t	0.320	1.481	1.704	2.227^＊	3.220^＊＊