基于超声图像的胸椎旁神经阻滞联合全身麻醉在腹腔镜食管癌根治术中的应用：胸椎旁神经阻滞与全身麻醉治疗食管癌的随机对照试验

Ultrasound image-based paravertebral nerve block combined with general anesthesia in laparoscopic radical resection of esophageal cancer : Paravertebral nerve block versus general anesthesia in the treatment of esophageal cancer: a randomized controlled trial.

作者信息

Yang Tingting, He Yuan

机构信息

Department of Anesthesia and Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China.

Department of Anesthesia and Surgery, Shaanxi Provincial Cancer Hospital, Xi'an, Shaanxi, 710061, China.

出版信息

World J Surg Oncol. 2025 Apr 10;23(1):136. doi: 10.1186/s12957-025-03772-8.

DOI:10.1186/s12957-025-03772-8

PMID:40211312

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11984185/

Abstract

BACKGROUND

Thoracic epidural analgesia (TEA) is the gold standard for analgesia after thoracotomy, but it has limitations. There are few studies on the analgesic effect of ultrasound-guided paravertebral nerve block (PVB) combined with general anesthesia in esophageal cancer surgery.

METHODS

52 TLE patients from November 2020 - November 2021 were randomly divided into Group G (general anesthesia, n = 26) and Group G + P (ultrasound - guided PVB + general anesthesia, n = 26). General data, intraoperative/postoperative indicators, VAS scores, HR, MAP, NTI, and patient satisfaction were recorded.

RESULTS

There were no significant differences in general data such as age, gender, BMI, and ASA grade between the two groups (P > 0.05). The intraoperative dosages of propofol, remifentanil, and sufentanil in Group G + P were significantly lower than those in Group G, while the dosage of phenylephrine was higher. The extubation time, PACU stay time, and postoperative hospital stay in Group G + P were shorter, the dosage of sufentanil in PACU was less, and the incidence of agitation was lower. The VAS scores of Group G + P in the resting and coughing states at multiple time points such as waking up, leaving the PACU, and after surgery were significantly lower than those of Group G. There was no significant difference in HR between the two groups at most time points during the operation. The MAP of Group G was higher than that of Group G + P at time points t8 and t9, and there were significant differences in NTI between the two groups from t2 to t7. The satisfaction rate of patients in Group G + P (96.14%) was significantly higher than that in Group G (80.76%).

CONCLUSION

Ultrasound - guided PVB combined with general anesthesia reduces opioid use, eases pain, lowers agitation, shortens hospital stay, and boosts satisfaction in esophageal cancer surgery patients.

摘要

背景

胸段硬膜外镇痛（TEA）是开胸术后镇痛的金标准，但存在局限性。关于超声引导下椎旁神经阻滞（PVB）联合全身麻醉在食管癌手术中的镇痛效果研究较少。

方法

选取2020年11月至2021年11月的52例胸段食管癌（TLE）患者，随机分为G组（全身麻醉，n = 26）和G + P组（超声引导下PVB + 全身麻醉，n = 26）。记录一般资料、术中和术后指标、视觉模拟评分（VAS）、心率（HR）、平均动脉压（MAP）、疼痛阈值指数（NTI）及患者满意度。

结果

两组患者年龄、性别、体重指数（BMI）、美国麻醉医师协会（ASA）分级等一般资料比较，差异无统计学意义（P > 0.05）。G + P组丙泊酚、瑞芬太尼、舒芬太尼术中用量明显低于G组，去氧肾上腺素用量高于G组。G + P组拔管时间、麻醉后复苏室（PACU）停留时间及术后住院时间较短，PACU舒芬太尼用量较少，躁动发生率较低。G + P组在苏醒、离开PACU及术后等多个时间点静息和咳嗽状态下的VAS评分均明显低于G组。术中多数时间点两组HR比较，差异无统计学意义。在t8和t9时间点G组MAP高于G + P组，从t2至t7两组NTI比较，差异有统计学意义。G + P组患者满意度（96.14%）明显高于G组（80.76%）。