Efficacy of ultrasound-guided erector spinae plane block for postoperative analgesia in patients un-dergoing video-assisted thoracoscopic pulmonary lobectomy: a comparison with paravertebral nerve block / 中华麻醉学杂志

ABSTRACT

Objective To evaluate the efficacy of ultrasound-guided erector spinae plane (ESP) block for postoperative analgesia in the patients undergoing video-assisted thoracoscopic pulmonary lobecto-my by comparing with paravertebral nerve block. Methods Ninety patients of both sexes, aged 18-64 yr, with body mass index of 20- 27 kg∕m2 , of American Society of Anesthesiologists physical statusⅠ-Ⅲ, scheduled for elective video-assisted thoracoscopic pulmonary lobectomy, were divided into 2 groups (n= 45 each) using a random number table ultrasound-guided paravertebral nerve block ( group P) and ultra-sound-guided ESP block group (group E). Morphine 0. 1 mg∕kg and parecoxib sodium 40 mg were intrave-nously injected at 30 min before surgery. Ultrasound-guided ESP and paravertebral nerve blocks were per-formed with 0. 5％ ropivacaine 20 ml after anesthesia induction in E and P groups, respectively. Both groups received patient-controlled intravenous analgesia with 0. 1％ morphine 100 ml after surgery, and the analgesia pump was set up with a 1 ml bolus dose, 8 min lockout interval and no background infusion. Parecoxib 40 mg was intravenously injected every 8 h. Operation time, anesthesia time and total consumption of intraoperative remifentanil were recorded. The operation time of nerve block and development of pleu-ral puncture and vascular injury during operation were also recorded. The cumulative consumption of mor-phine was recorded at 2, 4, 6, 24 and 48 h after surgery. The development of postoperative nausea and vomiting and respiratory depression was recorded. Tramadol 100 mg was intramuscularly injected as a rescue analgesic when the visual analog scale score was more than 3. Results The operation time of nerve block was significantly shorter in group E than in group P (P<0. 05). There was no significant difference in the total consumption of intraoperative remifentanil, cumulative consumption of morphine, incidence of nausea and vomiting or requirement for rescue analgesia between two groups (P>0. 05). Pleural puncture, vascu-lar injury, pruritus or respiratory depression was not found in two groups. Conclusion Ultrasound-guided ESP block provides better analgesic efficacy after operation than paravertebral nerve block in the patients un-dergoing video-assisted thoracoscopic pulmonary lobectomy.