肋横突间阻滞联合前锯肌平面阻滞与肋横突间阻滞用于电视辅助胸腔镜手术后镇痛的前瞻性随机对照试验。

Rhomboid intercostal block combined with sub-serratus plane block versus rhomboid intercostal block for postoperative analgesia after video-assisted thoracoscopic surgery: a prospective randomized-controlled trial.

机构信息

Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, Zhejiang Province, Jiaxing, China.

出版信息

BMC Pulm Med. 2021 Feb 25;21(1):68. doi: 10.1186/s12890-021-01432-7.

DOI:10.1186/s12890-021-01432-7

PMID:33632189

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7908696/

Abstract

BACKGROUND

Rhomboid intercostal block (RIB) and Rhomboid intercostal block with sub-serratus plane block (RISS) are the two types of plane blocks used for postoperative analgesia after video-assisted thoracoscopic surgery (VATS). This prospective randomized controlled trial was performed to analyze the postoperative analgesic effects of ultrasound-guided RIB block and RISS block after video-assisted thoracoscopic surgery.

METHODS

Ninety patients aged between 18 and 80 years, with American Society of Anesthesiologists physical status Classes I-II and scheduled for elective unilateral VATS were randomly allocated into three groups. In group C, no block intervention was performed. Patients in group RIB received ultrasound-guided RIB with 20-mL 0.375% ropivacaine and those in group RISS received ultrasound-guided RIB and serratus plane block using a total of 40-mL 0.375% ropivacaine. All patients received intravenous sufentanil patient-controlled analgesia upon arrival in the recovery room. Postoperative sufentanil consumption and pain scores were compared among the groups.

RESULTS

The dosages of sufentanil consumption at 24 h after the surgery in the RIB and RISS groups were significantly lower than that in group C (p < 0.001 and p < 0.001 for all comparisons, respectively), the postoperative Numerical Rating Scale (NRS) scores in the RIB and RISS groups at 0.5, 1, 3, 6, 12, 18, and 24 h after surgery when patients were at rest or active were significantly lower than that in group C (p < 0.05 for all comparisons). The required dosage of sufentanil and time to first postoperative analgesic request in groupRISS were less than those in the group RIB at 24 h after the surgery (p < 0.001 and p < 0.001 for all comparisons, respectively). Similarly, the Numerical Rating Scale scores for group RISS at 12, 18, and 24 h after the surgery when the patients were active were significantly lower than those for group RIB (p < 0.05 for all comparisons).

CONCLUSION

Both ultrasound-guided RIB block and RISS block can effectively reduce the demand for sufentanil within 24 h after VATS, and less sufentanil dosage is needed in patient with RISS block. Ultrasound-guided RIB block and RISS block can effectively relieve pain within 24 h after VATS, and RISS block is more effective.

摘要

背景

肋间神经阻滞（RIB）和肋间神经阻滞联合前锯肌平面阻滞（RISS）是用于电视辅助胸腔镜手术（VATS）后术后镇痛的两种平面阻滞方法。本前瞻性随机对照试验旨在分析超声引导 RIB 阻滞和 RISS 阻滞在 VATS 术后的镇痛效果。

方法

选择年龄在 18 至 80 岁之间，ASA 身体状况分级 I-II 级，拟行择期单侧 VATS 的 90 例患者，随机分为三组。C 组不进行阻滞干预。RIB 组患者接受超声引导下 RIB 阻滞，注入 20ml0.375%罗哌卡因；RISS 组患者接受超声引导下 RIB 阻滞联合前锯肌平面阻滞，注入 40ml0.375%罗哌卡因。所有患者在到达恢复室后均接受静脉舒芬太尼自控镇痛。比较三组患者术后舒芬太尼用量和疼痛评分。

结果

RIB 组和 RISS 组患者术后 24 小时舒芬太尼用量明显低于 C 组（p<0.001 和 p<0.001，均有统计学意义），RIB 组和 RISS 组患者术后 0.5、1、3、6、12、18 和 24 小时静息和活动时的数字评分量表（NRS）评分明显低于 C 组（p<0.05，均有统计学意义）。RISS 组患者术后 24 小时内舒芬太尼用量和首次术后镇痛需求时间均少于 RIB 组（p<0.001 和 p<0.001，均有统计学意义）。同样，RISS 组患者术后 12、18 和 24 小时活动时的 NRS 评分明显低于 RIB 组（p<0.05，均有统计学意义）。