Ultrasound-guided Serratus Anterior Plane Block Combined With Intercostal Nerve Block For Postoperative Analgesia In Patients Undergoing Robot-assisted Pulmonary Resections

Objective: To explore the postoperative analgesia effect of ultrasound-guided serratus anterior plane block combined with intercostal nerve block in patients undergoing robot-assisted pulmonary resections.Methods: 60 patients undergoing robot-assisted pulmonary resections in The Affiliated Hospital of Qingdao University from November 2019 to October 2020 were selected and divided into two groups(30 patients pear group)according to randomized digital table:serratus anterior plane block+intercostal nerve block(nerve block group,group B)and incision infiltration of local anesthesia group(group C).After the completion of operation,0.375% ropivacaine 40 ml was used for ultrasound-guided serratus anterior plane block combined with intercostal nerve block in group B,0.375% ropivacaine 40 ml was used for Incision infiltration of local anesthesia in group C.Patient-controlled intravenous analgesia(PCIA)was used in two groups from leaving postoperative anesthesia care unit(PACU)to 48 h after surgery: sufentanil 150μg,flurbiprofen axetil 150 mg,ondansetron 8mg and normal saline were added to 150 ml.The first dose was 2 ml,the background infusion volume was 2 ml/h and 1 ml bolus dose was controlled for 15 min.Pain was evaluated by Numerical Rating Scale(NRS).In order to maintain NRS≤4,flurbiprofen axetil 50 mg were used for remedial analgesia.NRS scores at rest and while coughing were recorded at the time when the patients left PACU and 6h,24 h and 48 h after surgery,the maximum NRS score and occurrence time were recorded as well.MAP,HR and Sp O2 were recorded when the patients left PACU and 6h,24 h and 48 h after surgery.The volume of analgesic drugs,the use of additional analgesic drugs were recorded within 48 h after operation.The incidence of cardiovascular adverse events,respiratory depression,postoperative nausea and vomiting(PONV)were recorded as well.Results:(1)Compared with group C,there were no significant differences in the age,body mass index(BMI),ASA degrade,the time of operation,the time of anesthesia,number of surgical incisions,the amount of sufentanil used intraoperative,the time of PACU(P>0.05).(2)MAP,HR and Sp O2 were no significant differences after surgery between the two groups(P>0.05).(3)NRS scores at rest and while coughing in the group B was significantly lower than group C at 24 h after surgery(P>0.05),while no significant differences were detected in NRS scores at when the patients left PACU、6h、48h after surgery,the maximum NRS score in the group B was significantly lower than group C(P>0.05),and the occurrence time of the maximum NRS score obviously later in group B(P>0.05).(4)The volume of analgesic drugs,the frequency of additional analgesics and the PONV were significantly less in group B(P<0.05).No significant differences were detected in the occurrence of other adverse effects.Conclusion: Compared with incision infiltration of local anesthesia,ultrasound-guided serratus anterior plane block combined with intercostal nerve block can provide better and more durable postoperative analgesia for patients undergoing robot-assisted pulmonary resections,without increasing the incidence of adverse reactions and is suitable for pain management after robot-assisted pulmonary resections.