Effect of ultrasound- guided erector spinae plane block on early pain after thoracoscopic lobectomy / 中国医师进修杂志

ABSTRACT

Objective To investigate the effect of ultrasound-guided erector spinae plane (ESP) block on early postoperative pain and stress response in patients undergoing thoracoscopic lobectomy. Methods Sixty American Society of Anesthesiologists statusⅠorⅡgrade patients who had underwent thoracoscopic lobectomy from June to December 2018 in Wenzhou People′s Hospital were selected. The patients were divided into combined group 1, combined group 2 and control group according to the random digits table method with 20 cases each. The patients in control group only received patient controlled intravenous anesthesia (PCIA) after surgery. While in combined group 1 and 2, unilateral ESP block was performed before skin cutoff or after surgery under the guidance of ultrasonography, respectively, to replenish PCIA administration. The mean arterial pressure (MAP), heart rate, plethysmography index (SPI), state entropy (SE) and reaction entropy (RE) before anesthesia induction, immediately after intubation, at the time of incision, and thoracoscopic cannulation, 30 min after surgery, and at the time of thoracoscopic cannula withdrawal were recorded. The visual analogue score (VAS) at rest and cough extubation immediately and 1, 6, 12, 24, 48 h after extubation were recorded. The compression number of analgesia pump, remedy number of sufentanil and incidence of adverse events 48 h after extubation were recorded. The levels of venous blood norepinephrine (NE), epinephrine (E) and cortisol immediately after surgery and 24 h after extubation were measured. Results Sixty patients completed the study. There were no statistical difference in intraoperative fluid volume, operation duration, MAP, heart rate, SPI, RE, SE, incidence of adverse events (nausea vomiting, urinary retention and itching) and remedy number of sufentanil (P＞0.05). Compared with control group, the rest VAS from extubation immediately to 48 h after extubation and cough VAS from extubation immediately to 24 h after extubation in combined group 1 and 2 were significantly lower than those in control group, and there were statistical differences (P＜0.05). The compression numbers of analgesia pump 1 to 24 h after extubation in combined group 1 and 2 were significantly lower than those in control group 1 (0, 1) and 1 (0, 1) times vs. 3 (2, 4) times, 2 (1, 3) and 1 (0, 2) times vs. 5 (2, 7) times, 3 (1, 4) and 3 (2, 5) times vs. 6 (3, 7) times, 1 (0, 1) and 2 (1, 3) times vs. 4 (2, 6) times, 4 (2, 5) and 4 (2, 5) times vs. 6 (3, 8) times, and there were statistical differences (P＜0.05). Immediately after operation ending, the NE, E and cortisol in combined group 1 were significantly lower than those in control group and combined group 2 (32.7 ± 7.3) ng/L vs. (88.7 ± 11.3) and (80.5 ± 13.4) ng/L, (44.5 ± 9.9) ng/L vs. (59.3 ± 10.2) and (55.6 ± 11.6) ng/L, (4.0 ± 2.6) mg/L vs. (25.4 ± 6.8) and (18.9 ± 5.3) mg/L, and there were statistical differences (P＜0.05); there were no statistical differences between control group and combined group 2 (P＞0.05). The NE, E and cortisol 24 h after extubation in combined group 1 and 2 were significantly lower than those in control group(52.3 ± 11.8) and (56.5 ± 14.4) ng/L vs. (160.6 ± 21.7) ng/L, (52.2 ± 13.6) and (51.8 ± 10.5) ng/L vs. (90.3 ± 20.5) ng/L, (6.2 ± 2.1) and (9.4 ± 5.3) mg/L vs. (40.8 ± 9.2) mg/L, and there were statistical differences (P＜0.05), there were no statistical differences between combined group 1 and combined group 2 (P＞0.05). Conclusions The ultrasound-guided ESP block combined with PCIA can provide favorable postoperative analgesia for thoracic surgery, and ESP block before skin incision, but not after chest closing, can provide better effects in reducing stress response.