超声引导下前锯肌平面阻滞联合竖脊肌平面阻滞在VAST肺叶切除术术中及术后镇痛的应用

方亮; 张皓琳; 包晓航; 吴卓熙; 蒋力; 李中奇; 李洪

doi:10.16016/j.1000-5404.201912183

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超声引导下前锯肌平面阻滞联合竖脊肌平面阻滞在VAST肺叶切除术术中及术后镇痛的应用

临床医学 | 更新时间：2026-01-09

- 超声引导下前锯肌平面阻滞联合竖脊肌平面阻滞在VAST肺叶切除术术中及术后镇痛的应用
- Ultrasound-guided serratus anterior plane block combined with erector spinae plane block for intra- and post-operative analgesia after video-assisted thoracoscopic lobectomy
- 第三军医大学学报 2020年42卷第8期页码：841-847
- 作者机构：
- 作者简介：
- 基金信息：
- DOI：10.16016/j.1000-5404.201912183
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- 收稿：2019-12-19，
  
  纸质出版：2020-04-30
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方亮, 张皓琳, 包晓航, 等. 超声引导下前锯肌平面阻滞联合竖脊肌平面阻滞在VAST肺叶切除术术中及术后镇痛的应用[J]. 第三军医大学学报, 2020,42(8):841-847.

Liang FANG, Haolin ZHANG, Xiaohang BAO, et al. Ultrasound-guided serratus anterior plane block combined with erector spinae plane block for intra- and post-operative analgesia after video-assisted thoracoscopic lobectomy[J]. Journal of Third Military Medical University, 2020, 42(8): 841-847.
方亮, 张皓琳, 包晓航, 等. 超声引导下前锯肌平面阻滞联合竖脊肌平面阻滞在VAST肺叶切除术术中及术后镇痛的应用[J]. 第三军医大学学报, 2020,42(8):841-847. DOI： 10.16016/j.1000-5404.201912183.

Liang FANG, Haolin ZHANG, Xiaohang BAO, et al. Ultrasound-guided serratus anterior plane block combined with erector spinae plane block for intra- and post-operative analgesia after video-assisted thoracoscopic lobectomy[J]. Journal of Third Military Medical University, 2020, 42(8): 841-847. DOI： 10.16016/j.1000-5404.201912183.

摘要

Abstract

Objective

To investigate the effect of ultrasound-guided serratus anterior plane block (SAPB) combined with erector spinae plane block (ESPB) on intraoperative opioid consumption and postoperative analgesia in patients undergoing video-assisted thoracoscopic (VAST) lobectomy.

Methods

A total of 120 patients undergoing elective VAST lobectomy were randomized into 4 groups before the operation. After general anesthesia

the patients were given ESPB (E group)

SAPB (S group)

SAPB+ESPB (SE group) and general anesthesia only (G group). All the patients received patient-controlled intravenous analgesia (PCIA) after the operation. The amount of intraoperative opioid consumption

postoperative Visual Analogue Scale (VAS) scores at rest and when coughing

and adverse events and complications associated with analgesia were recorded in all the cases.

Results

Compared with those in G group

the postoperative VAS scores were significantly lower in the other 3 groups (

0.05); the scores were significantly lower in S and SE groups than in E group (

0.05)

but showed no significant difference between SE and S groups (

0.05). The intraoperative consumption of opioids

duration of PACU stay and sedation irritability score were all significantly lower or shorter in E

S and SE groups than in G group (

0.01). The incidence of postoperative nausea

vomiting and pulmonary complications did not differ significantly among the 4 groups (

0.05). The mean length of hospital stay was significantly shorter in E

S and SE groups than in G group

and was significantly shorter in SE group than in E group (

0.05)

but showed no significant difference between S and SE groups or between E and S groups (

05)

although SE group had a shorter hospital stay than S group by 0.76 d.

Conclusion

Ultrasound-guided SAPB

ESPB

and particularly their combination can reduce the intraoperative dose of opioids during VAST lobectomy

lower the incidence of delirium in PACU and shorten the duration of PACU stay without increasing adverse reactions to promote the patients' early recovery and discharge.

关键词

Keywords

references

UMARI M CARPANESE V MORO V Postoperative analgesia after pulmonary resection with a focus on video-assisted thoracoscopic surgery Eur J Cardiothorac Surg 2018 53 5 932 938 10.1093/ejcts/ezx413 UMARI M, CARPANESE V, MORO V, et al . Postoperative analgesia after pulmonary resection with a focus on video-assisted thoracoscopic surgery[J ] . Eur J Cardiothorac Surg, 2018, 53(5):932-938.DOI:10.1093/ejcts/ezx413

WARDHAN R CHELLY J Recent advances in acute pain management: understanding the mechanisms of acute pain, the prescription of opioids, and the role of multimodal pain therapy F1000Res 2017 6 2065 10.12688/f1000research.12286.1 WARDHAN R, CHELLY J. Recent advances in acute pain management: understanding the mechanisms of acute pain, the prescription of opioids, and the role of multimodal pain therapy[J]. F1000Res, 2017, 6: 2065. DOI: 10.12688/f1000research.12286.1.

WANG L P WANG Y ZHANG X Serratus anterior plane block or thoracic paravertebral block for postoperative pain treatment after uniportal video-assisted thoracoscopic surgery: a retrospective propensity-matched study J Pain Res 2019 12 2231 2238 10.2147/JPR.S209012 WANG L P, WANG Y, ZHANG X, et al . Serratus anterior plane block or thoracic paravertebral block for postoperative pain treatment after uniportal video-assisted thoracoscopic surgery: a retrospective propensity-matched study[J ] . J Pain Res, 2019, 12: 2231-2238. DOI: 10.2147/JPR.S209012.

顾楠张析哲周琪超声引导下竖脊肌平面阻滞在胸科手术的临床应用进展世界最新医学信息文摘 2019 1 62 44,46 10.19613/j.cnki.1671-3141.2019.62.024 顾楠, 张析哲, 周琪.超声引导下竖脊肌平面阻滞在胸科手术的临床应用进展[J].世界最新医学信息文摘, 2019, 19(62):44, 46.DOI:10.19613/j.cnki.1671-3141.2019.62.024.

GU N ZHANG X Z ZHOU Q The clinical application of ultrasound-guided spinal muscle block in thoracic surgery World Latest Med Inf 2019 19 62 44,46 10.19613/j.cnki.1671-3141.2019.62.024 GU N, ZHANG X Z, ZHOU Q. The clinical application of ultrasound-guided spinal muscle block in thoracic surgery [J]. World Latest Med Inf, 2019, 19(62): 44,46. DOI: 10.19613/j.cnki.1671-3141.2019.62.024.

骆艺菲何开华前锯肌平面阻滞镇痛的临床应用进展山东医药 2019 59 8 103 106 10.3969/j.issn.1002-266X.2019.08.030 骆艺菲, 何开华.前锯肌平面阻滞镇痛的临床应用进展[J].山东医药, 2019, 59(8): 103-106. DOI: 10.3969/j.issn.1002-266X.2019.08.030.

LUO Y F HE K H Progress in clinical application of serratus anterior plane block analgesia Shandong Med J 2019 59 8 103 106 10.3969/j.issn.1002-266X.2019.08.030 LUO Y F, HE K H. Progress in clinical application of serratus anterior plane block analgesia [J]. Shandong Med J, 2019, 59(8): 103-106.DOI:10.3969/j.issn.1002-266X.2019.08.030

闫光明陈杰杨贵英两种非甾体类抗炎药联合氢吗啡酮在胸腔镜手术患者术后镇痛中的应用:一项随机、双盲、对照临床研究第三军医大学学报 2018 40 11 1011 1016 10.16016/j.1000-5404.201803125 http://aammt.tmmu.edu.cn/oa/darticle.aspx?type=view&id=201803125 闫光明, 陈杰, 杨贵英, 等.两种非甾体类抗炎药联合氢吗啡酮在胸腔镜手术患者术后镇痛中的应用:一项随机、双盲、对照临床研究[J].第三军医大学学报, 2018, 40(11):1011-1016.DOI:10.16016/j.1000-5404.201803125.

YAN G M CHEN J YANG G Y Analgesic effects of 2 nonsteroidal anti-inflammatory drugs respectively combined with hydromorphone in postoperative analgesia after thoracic surgery: a randomized, double blind, controlled clinical study J Third Mil Med Univ 2018 40 11 1011 1016 10.16016/j.1000-5404.201803125 http://aammt.tmmu.edu.cn/oa/darticle.aspx?type=view&id=201803125 YAN G M, CHEN J, YANG G Y, et al . Analgesic effects of 2 nonsteroidal anti-inflammatory drugs respectively combined with hydromorphone in postoperative analgesia after thoracic surgery: a randomized, double blind, controlled clinical study[J ] . J Third Mil Med Univ, 2018, 40(11): 1011-1016. DOI: 10.16016/j.1000-5404.201803125.

RIKER R R PICARD J T FRASER G L Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients Crit Care Med 1999 27 7 1325 1329 10.1097/00003246-199907000-00022 RIKER R R, PICARD J T, FRASER G L.Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients[J]. Crit Care Med, 1999, 27(7): 1325-1329. DOI:10.1097/00003246-199907000-00022.

AGOSTINI P CIESLIK H RATHINAM S Postoperative pulmonary complications following thoracic surgery: are there any modifiable risk factors? Thorax 2010 65 9 815 818 10.1136/thx.2009.123083 AGOSTINI P, CIESLIK H, RATHINAM S, et al . Postoperative pulmonary complications following thoracic surgery: are there any modifiable risk factors?[J ] . Thorax, 2010, 65(9): 815-818. DOI: 10.1136/thx.2009.123083.

BLANCO R PARRAS T MCDONNELL J G Serratus plane block: a novel ultrasound-guided thoracic wall nerve block Anaesthesia 2013 68 11 1107 1113 10.1111/anae.12344 BLANCO R, PARRAS T, MCDONNELL J G, et al . Serratus plane block: a novel ultrasound-guided thoracic wall nerve block[J ] . Anaesthesia, 2013, 68(11): 1107-1113. DOI: 10.1111/anae.12344.

FORERO M ADHIKARY S D LOPEZ H The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain Reg Anesth Pain Med 2016 41 5 621 627 10.1097/AAP.0000000000000451 FORERO M, ADHIKARY S D, LOPEZ H, et al . The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain[J ] . Reg Anesth Pain Med, 2016, 41(5): 621-627. DOI: 10.1097/AAP.0000000000000451.

EL-BOGHDADLY K PAWA A The erector spinae plane block: plane and simple Anaesthesia 2017 72 4 434 438 10.1111/anae.13830 EL-BOGHDADLY K, PAWA A. The erector spinae plane block: plane and simple[J]. Anaesthesia, 2017, 72(4): 434-438. DOI: 10.1111/anae.13830.

IVANUSIC J KONISHI Y BARRINGTON M J A cadaveric study investigating the mechanism of action of erector spinae blockade Reg Anesth Pain Med 2018 43 6 567 571 10.1097/AAP.0000000000000789 IVANUSIC J, KONISHI Y, BARRINGTON M J. A cadaveric study investigating the mechanism of action of erector spinae blockade[J]. Reg Anesth Pain Med, 2018, 43(6): 567-571. DOI: 10.1097/AAP.0000000000000789.

MAYES J DAVISON E PANAHI P An anatomical evaluation of the Serratus anterior plane block Anaesthesia 2016 71 9 1064 1069 10.1111/anae.13549 MAYES J, DAVISON E, PANAHI P, et al . An anatomical evaluation of the Serratus anterior plane block[J ] . Anaesthesia, 2016, 71(9): 1064-1069. DOI: 10.1111/anae.13549.

CHU G M JARVIS G C Serratus anterior plane block to address postthoracotomy and chest tube-related pain: a report on 3 cases A A Case Rep 2017 8 12 322 325 10.1213/XAA.0000000000000502 CHU G M, JARVIS G C. Serratus anterior plane block to address postthoracotomy and chest tube-related pain: a report on 3 cases[J]. A A Case Rep, 2017, 8(12): 322-325. DOI: 10.1213/XAA.0000000000000502.

JACQUES N KAROUTSOS S AUBRY K Peripheral nerve block efficacy on refractory neuralgia complicating Ramsay hunt syndrome: a case report A A Pract 2019 10.1213/XAA.0000000000001035 JACQUES N, KAROUTSOS S, AUBRY K, et al . Peripheral nerve block efficacy on refractory neuralgia complicating Ramsay hunt syndrome: a case report[J ] . A A Pract, 2019. DOI: 10.1213/XAA.0000000000001035.

NOBRE L V CUNHA G P DE SOUSA P C C B Bloqueio de nervos periféricos e dor rebote: revisão de literatura Braz J Anesthesiol 2019 69 6 587 593 10.1016/j.bjan.2019.05.001 NOBRE L V, CUNHA G P, DE SOUSA P C C B, et al . Bloqueio de nervos periféricos e dor rebote: revisão de literatura[J ] . Braz J Anesthesiol, 2019, 69(6): 587-593. DOI: 10.1016/j.bjan.2019.05.001.

YU D H CHAI W SUN X D Emergence agitation in adults: risk factors in 2, 000 patients J Can D'anesthesie 2010 57 9 843 848 10.1007/s12630-010-9338-9 YU D H, CHAI W, SUN X D, et al . Emergence agitation in adults: risk factors in 2, 000 patients[J ] . J Can D'anesthesie, 2010, 57(9): 843-848. DOI: 10.1007/s12630-010-9338-9.

RÜSCH D EBERHART L H WALLENBORN J Nausea and vomiting after surgery under general anesthesia: an evidence-based review concerning risk assessment, prevention, and treatment Dtsch Arztebl Int 2010 107 42 733 741 10.3238/arztebl.2010.0733 RÜSCH D, EBERHART L H, WALLENBORN J, et al .Nausea and vomiting after surgery under general anesthesia: an evidence-based review concerning risk assessment, prevention, and treatment[J ] . Dtsch Arztebl Int, 2010, 107(42): 733-741. DOI: 10.3238/arztebl.2010.0733.

APFEL C C KORTTILA K ABDALLA M A factorial trial of six interventions for the prevention of postoperative nausea and vomiting N Engl J Med 2004 350 24 2441 2451 10.1056/NEJMoa032196 APFEL C C, KORTTILA K, ABDALLA M, et al . A factorial trial of six interventions for the prevention of postoperative nausea and vomiting[J ] . N Engl J Med, 2004, 350(24): 2441-2451. DOI: 10.1056/NEJMoa032196.

CONNOLLY C MADDEN S F BUGGY D J Expression of anaesthetic and analgesic drug target genes in excised breast tumour tissue: Association with clinical disease recurrence or metastasis PLoS ONE 2017 12 5 e0177105 10.1371/journal.pone.0177105 CONNOLLY C, MADDEN S F, BUGGY D J, et al . Expression of anaesthetic and analgesic drug target genes in excised breast tumour tissue: Association with clinical disease recurrence or metastasis[J ] . PLoS ONE, 2017, 12(5): e0177105. DOI: 10.1371/journal.pone.0177105.

KHALIL A E ABDALLAH N M BASHANDY G M Ultrasound-guided Serratus anterior plane block versus thoracic epidural analgesia for thoracotomy pain J Cardiothorac Vasc Anesth 2017 31 1 152 158 10.1053/j.jvca.2016.08.023 KHALIL A E, ABDALLAH N M, BASHANDY G M, et al . Ultrasound-guided Serratus anterior plane block versus thoracic epidural analgesia for thoracotomy pain[J ] . J Cardiothorac Vasc Anesth, 2017, 31(1): 152-158. DOI: 10.1053/j.jvca.2016.08.023.

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