ABSTRACT
Objective To investigate the effect of ultrasound-guided serratus plane block (SAPB) on efficacy of postoperative analgesia in patients undergoing video- assisted thoracoscopic surgery. Methods Sixty patients scheduled for video- assisted thoracoscopic radical resection of lung cancer under general anesthesia from October 2017 to April 2018 were divided into 2 groups by random digits table method with 30 cases each: SAPB group and control group. After induction of anesthesia, ultrasound-guided homolateral SAPB was performed, and 0.5％ ropivacaine 20 ml was injected in SAPB group, while the equal volume of normal saline was used instead in control group. The patients received intravenous analgesia after operation in 2 groups. The scores of visual analogue score (VAS) and Bruggrmann comfort score (BCS) were evaluated at 1, 2, 4, 6, 12, 24 and 48 h after operation. The consumption of additional pain medication within 48 h after operation and remifentanil during operation were recorded. The adverse effects were also recorded. Results The VAS scores at postoperative 1, 2, 4, 8 and 12 h in SAPB group were significantly lower than those in control group: (2.70 ± 0.92) scores vs. (5.10 ± 2.04) scores, (2.80 ± 1.00) scores vs. (5.13 ± 1.78) scores, (3.07 ± 1.17) scores vs. (4.93 ± 1.53) scores, (3.13 ± 1.07) scores vs. (4.63 ± 1.47) scores and (2.87 ± 0.73) scores vs. (3.83 ± 1.29) scores, P <0.05; the BCS scores at postoperative 1, 2, 4, 8 and 12 h in SAPB group were significantly better than those in control group: (1.90 ± 0.66) scores vs. (0.93 ± 0.91) scores, (2.03 ± 0.41) scores vs. (0.90 ± 0.80) scores, (1.90 ± 0.40) scores vs. (1.07 ± 0.69) scores, (1.97 ± 0.32) vs. (1.20 ± 0.66) scores and (2.03 ± 0.18) scores vs. (1.73 ± 0.45) scores, and there were statistical differences (P<0.05). The dose of remifentanil consumption of additional pain medication within 48 h in SAPB group were significantly lower than those in control group: (0.23 ± 0.03) mg vs. (0.34 ± 0.03) mg and (26.67 ± 25.37) mg vs. (40.00 ± 24.21) mg, and there were statistical differences (P<0.05). There was no significant difference in the incidence of adverse reactions between 2 groups (P > 0.05). Conclusions The SAPB can reduce the early pain after video-assisted thoracoscopic radical resection of lung cancer, improve the comfort of patients, enhance the effect of postoperative analgesia and reduce the use of postoperative analgesic drugs.
ABSTRACT
Ultrasound-guided serratus anterior plane block is one of the ways to provide analgesia to post thoractomy.It appears to be more easily performed compared with other techniques and is applied to be a postoperative analgesia for chest surgery such as breast cancer,ribs fracture and lung cancer.The review studies the using of serratus anterior plane block in clinical pain management.
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Objective To compare the postoperative analgesic effect of ultrasonography-guided transversus abdominis plane (TAP) block and local wound infiltration in laparoscopic cholecystectomy (LC).Methods Fifty patients who underwent LC were randomly assigned to receive TAP block (T group) or local wound infiltration (A group).In group T,40 mL of 0.25％ mpivacaine was administered in TAP block.In group A,0.5％ ropivacaine was injected around the trocar and extraction site.Mean arterial pressure (MAP) and heart rate (HR) were recorded at baseline,before incision,and 3 min after pneumoperitoneum.The dosages of remifentanil and sufentanil and the incidence of postoperative nausea and vomiting (PONV) were also recorded.Visual analogue scale (VAS) scores for resting and coughing states were assessed at 0,1,2,6,and 24 hours after operation.Results Compared with group A,the dosage of remifentanil was less,and MAP and HR at 3 min after pneumoperitoneum were significantly lower in group T (P ＜ 0.05).No significant difference was found in VAS score at resting state.In group T,the VAS scores at coughing state in the postanesthesia care unit immediately,1 h,and 2 h after operation were lower than those in group A (P ＜ 0.05).The sufentanil dosage was less in group T than in group A (P ＜ 0.05).No significant difference was found in the incidence of PONV.Conclusion The postoperative analgesic effect of TAP block is the same as that in local wound infiltration.However,it can reduce the pain score in the movement state and reduce the opioid dosages.
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Objective To explore the effect of intravenous dexmedetomidine (0.4 μg·kg 1 ·h 1) on the recovery period in obese patients undergoing laparoscopic Roux-en-Y surgery.Methods Thirty patients (ASA Ⅰ to Ⅱ,body mass index ≥ 30 kg/m2) presenting for laparoscopic Roux-en-Y surgery under general anesthesia were randomly assigned 1:1 to the dexmedetomidine group (group D) or control group (group C).Dexmedetomidine was infused at 0.4 μg·kg-1·h-1 at the beginning of the operation and was discontinued 30 minutes before the end of the surgery in group D.Simultaneously,normal saline was infused at 0.4 μg· kg-1· h-1 in group C.The two groups received the same method of induction and maintenance anesthesia.The intraoperative variables measured included heart rate (HR),mean blood pressure (MBP),low frequency (LF),high frequency (HF),LF/HF ratio extubation time,Silverman-Andersen score (SAS) at the time of extubation,level of agitation during the recovery period,and adverse events.Results HR,MBP,and LF/HF of group C were higher than the baseline values and that of group D (P ＜ 0.05) during the recovery period.LF was higher in group C those in group D (P ＜ 0.05) during the recovery period.MBP was lower than the baseline values (P ＜ 0.05) and SAS at the time of extubation and level of agitation during the anesthesia recovery period were lower in group D (P ＜ 0.05) than in group C.There was no significant difference in HF and extubation time between the two groups (P ＞ 0.05).Conclusion Infusion of dexmedetomidine during anesthesia in obese patients may improve the quality of emergence from anesthesia without increasing the duration of the anesthesia recovery period.