超声辅助肋缘下腹横肌平面联合腹直肌鞘阻滞在胸腹腔镜食管癌手术中的优势OA
Advantages of Ultrasound-Guided Subcostal Transversus Abdominis Plane Block Combined with Rectus Sheath Block in Thoracoscopic-Laparoscopic Esophagectomy
目的 研究超声辅助肋缘下腹横肌平面阻滞(OTAPB)联合腹直肌鞘阻滞(RSB)对于胸腹腔镜食管癌(EC)手术患者术后镇痛的效果.方法 前瞻性选取2023 年11 月至2024 年5 月于安阳市肿瘤医院择期行胸腹腔镜 EC 手术的患者 80 例,随机分为对照组(采用超声辅助胸椎旁阻滞联合全身麻醉)和观察组(采用 OTAPB+RSB 联合全身麻醉),每组 40 例.两组均在麻醉诱导后实施神经阻滞操作,均使用 40 mL 0.25%罗哌卡因.术毕两组均给予自控静脉镇痛.主要观察指标:术后 2、4、8、12、18、24 h 静息及咳嗽状态下的 VAS 评分;术后 24 h 内PCA 按压次数及补救镇痛情况;神经阻滞操作时间.次要观察指标:不同时间点(未诱导时、未切皮时、切皮后10 min、关胸时、手术终止时、拔管后 30 min)的 MAP、HR 及 PPI;病灶部位、手术时长、术中瑞芬太尼、去甲肾上腺素及氢吗啡酮用量;以及术后 24 h 内穿刺点血肿、局麻药中毒、感染等神经阻滞相关并发症.结果 观察组术后24 h PCA 按压次数及补救镇痛需求均低于对照组(P<0.05);观察组术后4、8、12、18 h 的静息VAS 评分及术后2、4、8、12、18 h 的咳嗽 VAS 评分均低于对照组(P<0.05);观察组的神经阻滞操作时间亦低于对照组(P<0.05).结论 超声引导下 OTAPB 联合 RSB 操作简便,可有效缓解胸腹腔镜食管癌手术患者的腹部切口疼痛,降低术后疼痛评分.
Objective To investigate the analgesic efficacy of ultrasound-assisted subcostal transversus abdominis plane block(OTAPB)combined with rectus sheath block(RSB)for postoperative pain management in patients undergoing thoracoscopic-laparoscopic esophagectomy of esophageal cancer(EC).Methods 80 patients scheduled for elective thoracoscopic and laparoscopic esophagectomy at Anyang Cancer Hospital between November 2023 and May 2024 were prospectively randomized into two groups:the TP group(ultrasound-guided thoracic paravertebral block combined with general anesthesia,n=40)and the OR group(ultrasound-guided oblique subcostal transversus abdominis plane block combined with rectus sheath block and general anesthesia,n=40).Both groups underwent nerve block procedures after anesthesia induction,using 40 mL of 0.25%ropivacaine.Postoperatively,patient-controlled intravenous analgesia was provided to all patients.Primary outcomes included:visual analogue scale(VAS)scores at rest and during cough at 2 h,4 h,8 h,12 h,18 h,and 24 h postoperatively;number of PCA presses and rescue analgesia requirements within 24 h;and duration of nerve block procedure.Secondary outcomes included:MAP,HR,and PPI at predefined timepoints,surgical site,duration,intraoperative opioid and vasopressor use,and complications related to nerve block(hematoma,local anesthetic toxicity,infection)within 24 h postoperatively.Results Compared with the TP group,the OR group had significantly fewer PCA presses(P<0.05)and lower rescue analgesia requirements(P<0.05)within 24 h postoperatively.Additionally,the OR group demonstrated lower VAS scores at rest(4 h,8 h,12 h,18 h)and during cough(2 h,4 h,8 h,12 h,18 h)(P<0.05).The duration of the nerve block procedure was also shorter in the OR group(P<0.05).Conclusion Ultrasound-guided OTAPB+RSB is a more convenient technique that effectively manages postoperative abdominal incisional pain in patients undergoing thoracoscopic and laparoscopic esophagectomy,reducing postoperative pain scores.
刘杰;侯一凡;韩学宾
安阳市肿瘤医院麻醉科,河南 安阳,453000安阳市肿瘤医院麻醉科,河南 安阳,453000安阳市肿瘤医院麻醉科,河南 安阳,453000
医药卫生
超声引导肋缘下腹横肌平面阻滞腹直肌鞘阻滞胸椎旁阻滞食管癌手术VAS评分
ultrasound guidancesubcostal transversus abdominis plane blockrectus sheath blockthoracic paravertebral blockesophagectomyVAS score
《食管疾病》 2026 (2)
118-124,7
安阳市2023科技发展计划(重点研发与推广)项目(2023C01SF009)
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