布比卡因和罗哌卡因竖脊肌平面阻滞用于胸腔镜手术患者术后镇痛的比较

Comparison of Erector Spinae Plane Block with Bupivacaine and with Ropivacaine on Postoperative Analgesia in Patients Undergoing Thoracoscopic Surgery

关键词:  术后镇痛  竖脊肌平面阻滞  布比卡因  罗哌卡因  胸腔镜手术

Key words:  postoperative analgesia  erector spinae plane block  bupivacaine  ropivacaine  thoracoscopic surgery

摘要:

目的 比较布比卡因和罗哌卡因超声引导下竖脊肌平面阻滞用于胸腔镜手术患者术后镇痛的有效性和安全性。方法 随机将60例择期胸腔镜手术患者均分为布比卡因组（n=30）和罗哌卡因组（n=30）。全麻诱导前分别采用布比卡因或罗哌卡因行单次竖脊肌平面阻滞。观察患者阻滞范围及术后1，6，12，24，48 h静息和咳嗽疼痛视觉模拟评分（visual analogue scale，VAS）；记录术后48 h氟比洛芬酯给药次数及给药时间；观察竖脊肌平面阻滞后气胸等不良事件及术后恶心呕吐等不良反应发生情况。结果 布比卡因组阻滞范围稍广，但与罗哌卡因组比较差异无统计学意义（χ²=1.2，P>0.05）。布比卡因组术后1，6，12 h患者静息和咳嗽VAS评分低于同时点罗哌卡因组（P<0.05），术后24，48 h静息和咳嗽VAS评分高于组内术后12 h（P<0.05），术后48 h氟比洛芬酯使用人均次数小于罗哌卡因组（P<0.05）。2组术后第2个12 h氟比洛芬酯使用例次均高于同组术后第1个12 h（P<0.05）。2组竖脊肌平面阻滞后不良事件及术后不良反应发生情况差异无统计学意义。结论 布比卡因和罗哌卡因超声引导下单次竖脊肌平面阻滞用于胸腔镜手术患者术后镇痛，都是有效的和安全的，有效镇痛时间均仅12 h左右。比较而言，布比卡因镇痛效果更好。

Abstract:

OBJECTIVE To compare the effectivity and safety of ultrasound-guided single erector spinae plane block combined with bupivacaine and with ropivacaine on postoperative analgesia in patients undergoing thoracoscopic surgery. METHODS Sixty patients undergoing thoracoscopic surgery were randomly divided into group of ultrasound-guided single erector spinae plane block with bupivacaine (bupivacaine group, n=30) and group with ropivacain (ropivacain group, n=30). Erector spinae plane block was given to patients before anesthesia induction, and its effect was evaluated by testing the area of block. VAS scores of quiescent and VAS scores of cough were recorded at 1, 6, 12, 24 and 48 h after operation. The frequency and time of use flurbiprofen axetil 48 h after operation were recorded. The adverse events such as pneumothorax after ESP block and the adverse effects such as postoperative nausea and vomiting after operation were observed. RESULTS The block range in bupivacaine group was wider, but there was no significant difference compared with group ropivacain (χ²=1.2, P>0.05). The VAS scores both at quiescent and at cough in group bupivacaine at 1, 6, 12 h after operation were significantly lower than those in ropivacain group (P<0.05). The VAS scores both at quiescent and at cough in bupivacaine group at 24, 48 h after operation were significantly higher than that at 12 h after operation(P<0.05). The average frequency of use flurbiprofen axetil 48 h after operation in bupivacaine group was significantly less than that in ropivacain group(P<0.05). Both in bupivacaine group and ropivacain group, the frequency of use flurbiprofen axetil the second 12 h after operation were significantly higher than that the first 12 h after operation(P<0.05). There were no difference of the incidence of adverse events after ESP block and the adverse effects after operation in two groups(P<0.05). CONCLUSION Both with bupivacaine and with ropivacaine ultrasound-guided single erector spinae plane block on postoperative analgesia patients undergoing thoracoscopic surgery are effective and safe. Both bupivacaine and ropivacaine the duration of postoperative analgesia are only about 12 h. Compared with ropivacaine, bupivacaine is more effective.