超声引导下前锯肌平面阻滞联合肋间神经阻滞在单孔胸腔镜手术术后镇痛的应用

Ultrasound-Guided Serratus Anterior Plane Block Combined with Intercostal Nerve Block for Postoperative Analgesia in Patients Undergoing Single-Port Video-Assisted Thoracoscopic Surgery

摘要: 目的：探讨超声引导下前锯肌平面阻滞(serratus anterior plane block, SAPB)联合肋间神经阻滞(intercostal nerve block, INB)对单孔胸腔镜手术术后的镇痛效果。方法：选取择期行单孔胸腔镜下肺叶切除术患者60例，分为3组：前锯肌平面阻滞组(S组)、肋间神经阻滞组(I组)和前锯肌复合肋间神经阻滞组(SI组)，手术完成后按分组行神经阻滞，术毕3组患者均行静脉自控镇痛(patient-controlled intravenous analgesia, PCIA)。记录患者术后2 h、4 h、8 h、24 h和48 h的静息和咳嗽时VAS评分，记录术中舒芬太尼使用量，记录镇痛泵输注总量和氟比洛芬酯给药次数，记录恶心呕吐等不良反应情况。结果：术后48 h内SI组静息时和咳嗽时VAS评分明显低于S组和I组(P < 0.05)、I组4 h~8 h内静息时和咳嗽时VAS评分低于S组(P < 0.05)，2 h、24 h、48 h时两组的差异无统计学意义。SI组镇痛泵使用量少于S组和I组(P < 0.05)。氟比洛芬酯给药次数和患者不良反应比例三组无明显差异(P > 0.05)。结论：超声引导下前锯肌平面阻滞和肋间神经阻滞都有利于缓解术后疼痛，前锯肌平面阻滞联合肋间神经阻滞可提供更好的术后镇痛，且不增加其不良反应，更利于患者快速康复。

Abstract: Objectives: To explore the effect of ultrasound-guided serratus anterior plane block combined with intercostal nerve block postoperative analgesia in patients scheduled to undergo single-port video-assisted thoracoscopic surgery. Methods: A total of 60 patients undergoing single-port video-assisted thoracoscopic surgery were randomly divided into two groups: SAPB group (group S), INB group (group I) and SAPB combined with INB group (group SI). After the completion of operation, all of them underwent ultrasound-guided nerve block. Both groups received patient-controlled intravenous analgesia after surgery. VAS scores were recorded at 2 h, 4 h, 8 h, 24 h and 48 h after operation. The consumption of sufentanil during operation, the volume of analgesic drugs, the consumption of flurbiprofen axetil and the side-effects were recorded as well. Results: VAS scores at rest and while coughing in the group SI were significantly lower than group S and group I at 48 h hours after surgery, while VAS scores at rest and while coughing in the group I were lower than group S (P < 0.05) between 4 h and 8 h after surgery. The volume of analgesic drugs was significantly less in group SI (P < 0.05). No significant differences were detected in the frequency of additional analgesics and occurrence of adverse effects (P > 0.05). Conclusion: Both serratus anterior plane block and intercostal nerve block are effective methods to relieve pain after VATS, while combination of them is more beneficial, and do not increase its adverse reactions.