The Application Effect Of Erector Spinae Plane Block In Thoracotomy

ObjectiveUltrasound-guided erector spinae plane block?ESP?technique is a new analgesic technique that plays an important role in the intraoperative and postoperative analgesia of thoracic surgery.This aim of the study was to study the application effect of the combination of erector spinae plane block and patient-controlled intravenous analgesia?PCIA?on the left thoracic esophageal surgery,to discuss the analgesic effect and clinical value of this study.Method1.From March 2017 to December 2017,40 patients who had esophageal cancer plan-ning to open thoracotomy under general anesthesia were selected from the Affiliated Hospital of Taishan Medical College.Patients between the ages of 50 and 70,ASA grade?or?,signed anesthesia informed consent preoperatively.2.patients were randomly divided into erector spinal plan block combined with patient-controlled intravenous analgesia group?EP group?and patient-controlled intra-venous analgesia group?P group?.Ultrasound-guided left ESP block was given to patients in group EP before anesthesia induction,given 0.5%ropivacaine 30ml.Both two groups receive postoperative patient controlled intravenous analgesia?PCIA?.15mg ketorolac tro-methamine was given for rescuing analgesic.3.Obvervational index:The changes of MAP and HR were recorded at different time points,into the operating room?T0?,after ESP block?T2?,opening the thorax?T3?,single lung ventilation 10min?T4?,after extubation 10 min?T5?.The arterial blood gas PaO₂ and PaCO₂ were recorded after radial artery puncturing and after operation 24h without oxygen inhalation.The pain grade evaluated visual analogue scal?VAS?of rest and coughing at time points of 1h,3h,12h,24h,48h after operation were recorded.The number of pressing PCIA pump and residual dose at 24h and 48h after operation were recorded.The amount of ketorolac tromethamine used during 24h and 48h after operation was recorded.Nausea and vomiting,pruritus,respiratory depression?SPO₂<90%or respiratory rate<7 beats/min?and other adverse reactions were recorded.Result1.There was no significant difference in age,sex,height,weight,operation time between group E and group EP?P>0.05?2.Comparison of hemodynamic changes between the two groups:At T2 and T4,the MAP and HR of EP group were lower than those of P group?P<0.05?,and there was no significant difference between the two groups at T0,T1 and T3?P>0.05?3.PaO₂ and PaCO₂ were compared between the two groups:PaO₂ and PaCO₂ were not significantly different between the two groups before stepping into the operating room?P>0.05?;at 24 hours after operation,the PaO₂ in EP group was higher than that in P group and PaCO₂ was lower than that in P group?P<0.05?.4.Analgesic effect comparison:?1?In the postoperative 1h,3h,12h,resting VAS score EP group compared with P group was lower,with statistical significance?P<0.05?;At 24h and 48h after surgery,the resting VAS score had no significance in the two groups?P>0.05?;The VAS score of cough during 24h after operation was significantly lower than that of P group?P<0.05?;There was no statistical difference in the cough VAS score between the two groups at 48h postoperatively?P>0.05?.The average number of PCIA presses in the EP group was significantly lower than that in the P group in postoperative 24hours?P<0.05?;the average number of PCIA presses within 24-48 hours after the operation was not statistically significant between the two groups?P>0.05?.?2?Compared the average consumption of PCIA pump within postoperative 24h,EP group was significantly less than the P group?P<0.05?;within 24-48h the average consumption of PCIA pump in the two groups had no difference?P>0.05?.5.The incidence of adverse reactions compared:The incidence of nausea in the EP group was lower than the P group within 24 hours after the operation?P<0.05?.There was no significant difference in the incidence of adverse reactions such as vomiting,pruritus,and respiratory depression in the two groups?P>0.05?.ConclusionsErector spinae plane block can be used as an effective perioperative analgesia during thoracic esophageal surgery,which can reduce the impact of surgery and pain stimuli on blood pressure and heart rate in patients,improve postoperative oxygenation,and may reduce the dosage and side effects of opioids and related analgesics.