Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, the First Affiliated Hospital of Soochow University, Suzhou.
Department of Anesthesiology.
Medicine (Baltimore). 2021 Jan 22;100(3):e24352. doi: 10.1097/MD.0000000000024352.
The effectiveness of anterior serratus plane block in postoperative analgesia of thoracic surgery is beginning to emerge. Currently, there are 2 methods of anterior serratus plane block: deep serratus plane block (DSPB) and superficial serratus plane block (SSPB). In clinical practice, there is no an unified view regarding the advantages and disadvantages between 2 methods. This study aimed to observe and compare the analgesic effects of 2 methods on patients undergoing thoracoscopic lobectomy, in order to provide some suggestions for anesthesiologists when they choose anterior serratus plane block to perform postoperative analgesia for patients. Patients were randomly divided into 3 groups (21 patients/group): 1. general anesthesia group (P group); 2. combined general anesthesia and SSPB group (S group), and 3. combined general anesthesia and DSPB group (D group). The patients in groups S and D received 0.4 ml/kg of 0.375% ropivacaine for ultrasound-guided block after surgery. Postoperatively, flurbiprofen was used for rescue analgesia. Visual analog scale (VAS) pain scores were recorded at 6 hours, 12 hours, and 24 hours after surgery, and rescue analgesia, post-operative nausea, and vomiting were reported within 24 hours after surgery. At 6 hours, 12 hours, and 24 hours, the VAS scores and the rescue analgesia rates in groups S and D were significantly lower than those in group (all < .001). With prolonging time, the VAS in group D was significantly increased by 0.11 per hour as compared with that of group ( < .0001); VAS in group D was significantly increased by 0.12 per hour as compared with that of group S ( < .0001). Ultrasound-guided anterior serratus plane block can provide adequate analgesia for patients undergoing thoracoscopy lobectomy. SSPB can significantly improve VAS scores as compared to DSPB at 24 hours.
前锯肌平面阻滞在胸外科手术后镇痛中的有效性开始显现。目前,前锯肌平面阻滞有 2 种方法:深前锯肌平面阻滞(DSPB)和浅前锯肌平面阻滞(SSPB)。在临床实践中,对于这 2 种方法的优缺点尚无统一的看法。本研究旨在观察和比较 2 种方法对行胸腔镜肺叶切除术患者的镇痛效果,为麻醉医师选择前锯肌平面阻滞为患者行术后镇痛提供一些建议。患者随机分为 3 组(每组 21 例):1. 全身麻醉组(P 组);2. 全身麻醉联合 SSPB 组(S 组)和 3. 全身麻醉联合 DSPB 组(D 组)。术后 S 组和 D 组患者接受超声引导下 0.4ml/kg 浓度为 0.375%罗哌卡因阻滞。术后采用氟比洛芬酯补救镇痛。记录术后 6、12、24 小时的视觉模拟评分(VAS)疼痛评分,并记录术后 24 小时内的补救镇痛、术后恶心呕吐情况。术后 6、12、24 小时,S 组和 D 组的 VAS 评分和补救镇痛率明显低于 P 组(均 < .001)。随着时间的延长,D 组 VAS 评分每小时增加 0.11,与 P 组比较差异有统计学意义( < .0001);D 组 VAS 评分每小时增加 0.12,与 S 组比较差异有统计学意义( < .0001)。超声引导下前锯肌平面阻滞可为行胸腔镜肺叶切除术的患者提供充分的镇痛。SSPB 可明显改善 24 小时时的 VAS 评分,优于 DSPB。