前锯肌平面阻滞和胸椎旁神经阻滞在胸腔镜手术中的麻醉效果及对疼痛因子的影响

Effect of anesthetic effects on pain factors of anterior serratus muscle plane block and thoracic paravertebral nerve block after thoracoscopic surgery

摘要:

目的 研究前锯肌平面阻滞与胸椎旁神经阻滞对胸腔镜手术患者的麻醉效果及对疼痛因子的影响。方法 选取2020年11月—2021年9月安徽省池州市人民医院60例接受胸腔镜手术治疗的患者作为研究对象，按照随机数字表法分为A组和B组，每组30例。两组患者术中均接受气管插管全身麻醉，麻醉诱导前，A组选择前锯肌平面阻滞，B组选择胸椎旁神经阻滞。比较两组患者的麻醉效果、阻滞操作时间、阻滞起效时间、阻滞持续时间、生命体征、术后镇痛泵按压次数、术后舒芬太尼使用量、疼痛因子、术后疼痛评分及术后不良反应发生率。结果 A组的麻醉优良率为96.67%，B组的麻醉优良率为93.33%，两组比较，差异无统计学意义（P >0.05）。两组患者的麻醉平面、阻滞起效时间比较，差异无统计学意义（P >0.05）；A组较B组阻滞操作时间缩短，阻滞持续时间延长。两组患者切皮前后收缩压、舒张压、心率差值比较，差异无统计学意义（P >0.05）。A组的术后48 h内镇痛泵按压次数、术后舒芬太尼使用量较B组减少（P <0.05）。两组患者手术前后血清PGE₂、IL-6差值比较，差异有统计学意义（P <0.05）。两组患者不同时间点间静息、咳嗽状态下VAS评分结果：①不同时间点的VAS评分有差异（P <0.05）；②A组与B组的VAS评分有差异（P <0.05）；③A组与B组的VAS评分变化趋势有差异（P <0.05）。两组术后不良反应发生率比较，差异无统计学意义（P >0.05）。结论 前锯肌平面阻滞与胸椎旁神经阻滞在胸腔镜手术中均可发挥良好的麻醉阻滞作用，有效维持术中生命体征稳定，但相比于胸椎旁神经阻滞，前锯肌平面阻滞可缩短阻滞时间，延长阻滞持续时间，有利于减少术后疼痛因子释放，达到良好的术后镇痛效果，还可减少术后阿片类镇痛药物的使用剂量，不良反应少。

Abstract:

Objective To compare the anesthetic effect of anterior serratus plane block and thoracic paravertebral nerve block in patients undergoing thoracoscopic surgery and its effect on pain factors.Methods From November 2020 to September 2021, 60 patients who received thoracoscopic surgery in our hospital were selected as the research objects, and were randomly divided into group A and group B with 30 cases each. Two groups of patients received general anesthesia with endotracheal intubation during operation. Before anesthesia induction, group A underwent anterior serratus block and group B underwent thoracic paravertebral nerve block. The anesthetic effect, anesthesia plane，block operation time, block onset time, block duration, vital signs index, postoperative analgesia pump compression times, postoperative sufentanil consumption, pain factor index, postoperative pain score, and postoperative adverse reaction rate were compared between the two groups.Results The excellent and good rate of anesthesia was 96.67% in Group A and 93.33% in group B，which were no significant between two groups (P > 0.05). There was no significant difference between the two groups in terms of anesthesia level and block onset time (P > 0.05), but the block operation time of group A was shorter than that of group B (P < 0.05), and the block duration of group A was longer than that of group B (P < 0.05). The systolic blood pressure, diastolic blood pressure, and heart rate between the two groups had no significant changes after skin incision compared with those before skin incision (P > 0.05). The pressing times of analgesic pump and the use of sufentanil in group A within 48 hours after operation were less than those in group B (P < 0.05). The difference of serum PGE2 and IL-6 between the two groups before and after operation was statistically significant (P < 0.05). There were differences in VAS scores between the two groups at different time points after operation in the state of rest and cough (P < 0.05). There was no significant difference in the incidence of postoperative adverse reactions between the two groups (P > 0.05).Conclusion Both the anterior serratus muscle plane block and thoracic paravertebral nerve block can play a good anesthetic blocking role in thoracoscopic surgery, and effectively maintain the stability of vital signs during operation. However, compared with thoracic paravertebral nerve block, the anterior serratus muscle plane block can shorten the blocking time, prolong the blocking duration, reduce the release of postoperative pain factors, achieve good postoperative analgesic effect, and reduce the dosage of opioid analgesics after operation, with few adverse reactions.