Department of Infectious Disease, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
Departments of Critical Care Medicine, Linyi People's Hospital, Linyi, Shandong, China.
Int J Clin Pract. 2022 Jun 23;2022:6924489. doi: 10.1155/2022/6924489. eCollection 2022.
Thoracic surgery is one of the most painful surgical steps. An important tool for managing postoperative pain is effective postoperative analgesia. This research aimed at comparing the analgesic roles of three new fascial block techniques in the postoperative period after video-helped thoracoscopic operation (VATS).
We randomly allocated ninety patients into three teams experiencing ultrasound-directed serratus plane block, erector spinae plane block, and the rhomboid intercostal block, respectively. 0.4% ropivacaine of 20 mL was received by all groups. At 0-12 hours, sufentanil consumption was significantly lower in the RIB (35.2 ± 3.3 mg) and ESP (35.4 ± 2.8 mg) groups than that in the SAB (43.3 ± 2.7 mg) group ( < 0.001), and no obvious diversity in sufentanil consumption was shown between the RIB and ESP groups (=0.813). At 12-24 hours, sufentanil consumption was greatly lower in the RIB and ESP groups than that in the SAB group ( < 0.001), and no great diversity in sufentanil consumption was found between the RIB and ESP groups (=0.589). No great diversity in sufentanil consumption was shown between the RIB (50.4 ± 1.4 mg), ESP (50.4 ± 1.5 mg), and SAB (51.0 ± 1.7 mg) groups at 24-48 hours (=0.192). At 6, 12, 18, and 24 hours, the postoperative dynamic NRS scores were significantly lower in the RIB and ESP groups than in the SAB group (( < 0.05) for all contrasts). Nevertheless, no great diversity was observed in postoperative pain marks at 0.5, 1, 3, 6, 12, 18, 24, 36, and 48 hours after the surgery across the three groups. No statistical diversity was found in the postoperative NRS mark between groups RIB and ESP within 48 hours after surgery in case of active patients (( < 0.05) for all contrasts). At 24 hours after surgery, a significant difference in IL-1 and IL-6 inflammatory factor concentrations was found between RIB and ESP compared with SAB block (( < 0.05) for all contrasts). However, no great diversities were observed in IL-1, and IL-6 inflammatory factor concentrations between RIB, ESP, and SAB at 24 hours preoperatively and at 48 hours postoperatively (( < 0.05) for all comparisons).
The dosage of sufentanil can be effectively reduced by ultrasound-directed rhomboid intercostal block and erector spinae plane block within 24 hours after VATS surgery, and pain can be relieved effectively within 24 hours by comparing with serratus plane block.
胸外科是最痛苦的外科手术之一。管理术后疼痛的一个重要工具是有效的术后镇痛。本研究旨在比较三种新的筋膜阻滞技术在电视辅助胸腔镜手术后（VATS）术后的镇痛作用。
我们将 90 名患者随机分配到三组，分别接受超声引导下的锯肌平面阻滞、竖脊肌平面阻滞和菱形肋间阻滞。三组均接受 0.4%罗哌卡因 20ml。在 0-12 小时时，RIB（35.2±3.3mg）和 ESP（35.4±2.8mg）组的舒芬太尼消耗量明显低于 SAB（43.3±2.7mg）组（<0.001），RIB 和 ESP 组之间舒芬太尼消耗量无明显差异（=0.813）。在 12-24 小时时，RIB 和 ESP 组的舒芬太尼消耗量明显低于 SAB 组（<0.001），RIB 和 ESP 组之间舒芬太尼消耗量无明显差异（=0.589）。在 24-48 小时时，RIB（50.4±1.4mg）、ESP（50.4±1.5mg）和 SAB（51.0±1.7mg）组之间舒芬太尼消耗量无明显差异（=0.192）。在术后 6、12、18 和 24 小时，RIB 和 ESP 组的动态 NRS 评分明显低于 SAB 组（所有比较均为<0.05）。然而，在术后 0.5、1、3、6、12、18、24、36 和 48 小时，三组之间的术后疼痛标记物无明显差异。在术后 48 小时内，活动患者的 RIB 和 ESP 组之间的术后 NRS 标记物无统计学差异（所有比较均为<0.05）。在术后 24 小时，与 SAB 阻滞相比，RIB 和 ESP 组的 IL-1 和 IL-6 炎症因子浓度有显著差异（所有比较均为<0.05）。然而，在术前 24 小时和术后 48 小时，RIB、ESP 和 SAB 之间的 IL-1 和 IL-6 炎症因子浓度无明显差异（所有比较均为<0.05）。
在 VATS 手术后 24 小时内，超声引导下的菱形肋间阻滞和竖脊肌平面阻滞可有效减少舒芬太尼的用量，并可在 24 小时内有效缓解疼痛，与锯肌平面阻滞相比。
