高位胸段竖脊肌平面阻滞在肩关节镜手术中的应用

Application of High Thoracic Erector Spinae Plane Block in Shoulder Arthroscopic Surgery

摘要: 目的：比较超声引导下高位胸段竖脊肌平面阻滞(High Thoracic Erector Spinae Plane Block, HT-ESPB)和肌间沟臂丛神经阻滞(Interscalene Nerve Block, ISB)在肩关节镜手术围手术期的效果和安全性。方法：本研究为前瞻性、随机、对照临床试验，纳入2024年1月至2024年12月期间接受肩关节镜手术的患者62例，随机分为ISB组(I组)和HT-ESPB组(H组)，每组各31例。I组接受超声引导下ISB，H组接受超声引导下T2水平HT-ESPB，两组均分别注射0.33%罗哌卡因20 ml，并联合全身麻醉。主要研究终点为术后入PACU 30 min时膈肌麻痹发生率，次要研究终点包括术中血流动力学变化、术中麻醉药物使用量、术后NRS疼痛评分、术后并发症及患者满意度评分等。结果：本研究共纳入62例患者，排除脱落病例后每组各30例。两组患者的基本资料差异无统计学意义(P > 0.05)。H组患者术后入PACU 30 min时膈肌麻痹发生率显著低于I组(0% vs. 93%, P < 0.001)。H组术中瑞芬太尼用量显著高于I组(P < 0.05)。H组患者术后入PACU 30 min、术后2 h、术后6 h静息痛NRS评分较I组更高(P < 0.05)。H组术后24 h患者满意度评分高于I组(P < 0.05)。在其余观察指标上未见显著差异(P > 0.05)。结论：肩关节镜手术中应用HT-ESPB能达到与ISB类似的镇痛效果，且膈肌麻痹发生率更低，患者满意度高。

Abstract: Objective: To compare the effect and safety of ultrasound-guided high thoracic erector spinae plane block (HT-ESPB) and interscalene nerve block (ISB) in the perioperative period of shoulder arthroscopic surgery. Methods: This prospective, randomized, controlled clinical trial enrolled 62 patients undergoing arthroscopic shoulder surgery from January 2024 to December 2024. Patients were randomly assigned to the ISB group (I group, n = 31) or the HT-ESPB group (H group, n = 31). The I group received ultrasound-guided ISB, while the H group received ultrasound-guided T2-level HT-ESPB. Both groups received 20 mL of 0.33% ropivacaine combined with general anesthesia. The primary outcome was the incidence of HDP at 30 min postoperatively in the post-anesthesia care unit (PACU). Secondary outcomes included intraoperative hemodynamic parameters, intraoperative anesthetic consumption, postoperative pain numerical rating scale (NRS) scores, complications, and patient satisfaction scores. Results: This study enrolled 62 patients. After excluding cases lost to follow-up, 30 patients were analyzed in each group. Baseline characteristics were no differences between the groups (P > 0.05). The incidence of HDP at PACU 30 min was significantly lower in the H group than in the I group (0% vs. 93%, P < 0.001). The intraoperative remifentanil consumption was significantly higher in the H group compared to the I group (P < 0.05). The resting NRS scores at PACU 30 min, 2 h postoperatively, and 6 h postoperatively were higher in the H group than in the I group (P < 0.05). Patient satisfaction scores at 24 h postoperatively were significantly higher in the H group (P < 0.05). There was no significant difference in other indexes (P > 0.05). Conclusion: Compared with ISB, HT-ESPB in shoulder arthroscopic surgery can achieve similar analgesic effects with a lower incidence of diaphragmatic paralysis and higher patient satisfaction.