Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, Zhejiang Province, Jiaxing, China.
BMC Pulm Med. 2021 Feb 25;21(1):68. doi: 10.1186/s12890-021-01432-7.
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.
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.
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).
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.
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。
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。
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）。
超声引导 RIB 阻滞和 RISS 阻滞均可有效减少 VATS 后 24 小时内舒芬太尼的需求，RISS 阻滞患者需要的舒芬太尼剂量更少。超声引导 RIB 阻滞和 RISS 阻滞均可有效缓解 VATS 后 24 小时内的疼痛，RISS 阻滞更有效。
