超声引导下RISS阻滞对胸腔镜手术患者术后镇痛的影响

Postoperative analgesic efficacy of ultrasound-guided RISS plane block in patients undergoing thoracoscopic surgery

摘要:

目的 评价超声引导下RISS阻滞在胸腔镜手术中的安全性和有效性。方法 选取2019年7月—2019月11月于西南医科大学附属医院择期行胸腔镜手术的患者60例，根据不同麻醉方法将患者分为RP组、LP组。两组均行全身麻醉，RP组全身麻醉前实施超声引导下RISS阻滞，LP组由手术医生在术毕行切口局部麻醉。记录RP组RISS阻滞20 min后在锁中线处的感觉阻滞范围；记录术中舒芬太尼用量、血管活性药物使用情况及瑞芬太尼用量；比较术后舒芬太尼消耗总量、24 h镇痛泵按压次数、补救性镇痛；比较入PACU时及术后2 h、6 h、12 h、24 h静息和咳嗽时VAS评分及各时间点咳嗽能力评分；比较PACU停留时间、术后首次下床活动时间、拔除引流管时间及术后住院时间；比较不良反应及患者满意度等。结果 RP组瑞芬太尼用量较LP组低（P <0.05）。RP组不同时间点的静息时或咳嗽时VAS评分均低于或等于LP组（P <0.05）。RP组或LP组咳嗽时不同时间点的VAS评分较静息时高。两组患者咳嗽能力评分比较，差异有统计学意义（P <0.05）。RP组术后舒芬太尼用量、24 h镇痛泵按压次数较LP组少，补救性镇痛较LP组低（P <0.05），满意度较LP组高（P <0.05）。RP组术后PACU停留时间、首次下床活动时间较LP组短（P <0.05）。RP组术后1例（3.3%）发生头晕，LP组为2例（6.7%）。RP组2例（6.7%）发生恶心呕吐，LP组为8例（26.7%），两组各发生低血压1例（3.3%），两组均无呼吸抑制、皮肤瘙痒；RP组没有发生神经阻滞相关并发症。结论 超声引导下RISS阻滞用于胸腔镜手术中是安全有效的，可以作为术后镇痛的辅助技术。

Abstract:

Objective To evaluate the safety and analgesic efficacy of ultrasound-guided rhomboid intercostal and subserratus (RISS) plane block in patients undergoing thoracoscopic surgery.Methods Sixty patients scheduled for elective thoracoscopic surgery in our hospital from July 2019 to November 2019 were enrolled and randomly divided into RP group (n = 30) with combined RISS plane block and patient-controlled intravenous analgesia (PCIA), and LP group (n = 30) with combined local anesthesia at the site of the incision and PCIA. Patients in both groups underwent general anesthesia. For RP group, patients received ultrasound-guided RISS plane block before the general anesthesia. For LP group, patients received local anesthesia at the end of surgery. The range of sensory block at the midclavicular line 20 min after RISS plane block was recorded in RP group. The intraoperative dosage of sufentanil, vasoactive drugs and remifentanil was documented. Postoperative sufentanil consumption, frequency of PCIA pump pressing, incidence of remedial analgesia, Visual Analogue Scale (VAS) scores of patients at rest and during cough at 0 h, 2 h, 6 h, 12 h and 24 h after operation in the post-anesthesia care unit (PACU), and semiquantitative cough strength score (SCSS) at each time point were recorded or evaluated. The length of PACU stay, time to first out-of-bed activity, the time of drainage tube withdrawal, length of postoperative hospital stay, adverse reactions and patient satisfaction were compared between the groups.Results The intraoperative dosage of remifentanil in RP group was lower than that in LP group (P < 0.05). The VAS scores at rest or during cough at each time point after surgery in the RP group were not higher than those in the LP group (P <0.05), while VAS scores during cough were higher than those at rest at each time point after surgery in both RP group and LP group (P < 0.05). The SCSS was significantly different between the two groups (P < 0.05). The postoperative sufentanil consumption, frequency of PCIA pump pressing and the incidence of remedial analgesia were lower in RP group compared with those in LP group (P < 0.05), and the degree of patient satisfaction in RP group was higher (P <0.05). The patients in the RP group exhibited a shorter length of PACU stay and time to first out-of-bed activity (P <0.05). The incidence of dizziness was 3.3% in RP group and 6.7% in LP group, while the incidence of nausea and vomiting was 6.7% in RP group but 26.7% in LP group. One case of hypotension was observed in each group, but there was no respiratory depression or pruritus in either group. Besides, no complications associated with RISS plane block occurred in RP group.Conclusions Ultrasound-guided RISS plane block is safe and effective for patients undergoing thoracoscopic surgery, and could be established as an adjuvant treatment for postoperative analgesia.