| Objective:To observe the analgesic effect of different methods ultrasound-guided serratus anterior plane block after operation in patients who have undergone video-assisted thoracoscopic surgery in general anesthesia combined with thoracic paravertebral nerve block,and to preliminarily explore its influence on the perioperative enhanced recovery of such patients.Method:One hundred and twenty patients of ASA Ⅰ～Ⅲ,aged 18～65y,BMI20～25 scheduled for video-assisted thoracoscopic surgery from October 2019 to December 2019 in Tianjin Chest Hospital were randomly divided into three groups:group PCIA(group control),group SPB and group CSPB(n=40 each).After entering the operating room,all patients in the three groups were treated with double-cavity endotracheal intubation general anesthesia combined with double-point(T4,T7)thoracic paravertebral block.Group SPB were received an ultrasound-guided single serratus plane block with 15ml of 0.375%ropivacaine on the operation side after surgery.Group CSPB did the same way as group SPB and have the epidural catheter inserted for 5cm fixation.Both the group PCIA and the group SPB were received patient-controlled intravenous analgesia after the surgery.The formula was:sufentanil 2～3μg/kg+butorphanol 12mg+0.9%sodium chloride injection to 150 ml,the background dose was 2 ml/h,the PC A dose was 2 ml,and the locking time was 15 min.The CSPB group were connected with a continuous serratus block automatic analgesia pump after surgery.The formula was 0.2%ropivacaine normal saline 300ml,the background dose was 6ml/h,the PCA dose was 6ml,and the locking time was 45min.Relevant data and hemodynamic indexes needed for the experiment of patients were recorded one day before surgery(T0),after induction of general anesthesia(T1),1h after surgery(T2),6h after surgery(T3),12h after surgery(T4),24h after surgery(T5),and 48h after surgery(T6).The data were recorded including the resting and motor Visual Analogue Scale(VAS)at T2、T3、T4、T5、T6,the QoR-40 scores at T0、T6,partial arterial oxygen pressure(PaO2),lactic acid level(Lac)and blood glucose level(Glu)at T1、T4、T5.The time of the first analgesia and the times of pressing PCA pump,the first time of getting out of bed after surgery,total length of hospitalization(days),adverse effects and incidence of chronic pain were also recorded.Result:There were not statistical significance among the three groups when comparing the general conditions gender,age,BMI,duration of operation,intraoperative blood loss of patients and the global QoR-40 total score at T0(P>0.05).The PaO2、Lac and Glu at T1、T4、T5 and incidence of chronic pain also had no statistical differences(P>0.05).Compared with group PCIA,the resting and motor VAS pain scores at T2、T3、T4、T5 were lower in group SPB and CSPB(P<0.05);compared with group SPB,motor VAS pain scores at T4、T5 were higher in group CSPB(P<0.05).Compared with group PCIA,the global QoR-40 total score at T6 were significantly higher in group SPB and CSPB;compared with group SPB,this data was higher in group CSPB(P<0.05).Compared with group PCIA,the time of the first analgesia were significantly prolonged and the times of pressing PCA pump、opioid use were significantly less in group SPB and group CSPB,and group CSPB used no opioids(all P<0.05);compared with group SPB,these data had no statistical differences in group CSPB(P>0.05).Compared with group PCIA,the first time of getting out of bed after surgery was shortened and the total length of hospitalization was lower in group SPB and CSPB;these data in group SPB was more lower(all P<0.05).Postoperative complications such as nausea,vomiting,dizziness in the group SPB and CSPB were significantly less than that in the group PCIA,and group CSPB were more less(P<0.05).Conclusion:As a component of multi-mode analgesia after VATS,single ultrasound-guided serratus anterior plane block combined with patient-controlled intravenous analgesia can provide better analgesic effect,improve the quality of early postoperative recovery(48h),and accelerate the process of patients ERAS. |
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