Erector Spinae Plane Block On Perioperative Analgesia For Video-assisted Thoracic Surgery

ObjectiveThe purpose of this research is to explore the advantages and disadvantages of erector spinae plane block for postoperative analgesia in thoracoscope radical resection of lung cancer,and to provide clinical basis for the regional analgesia scheme in video-assisted thoracic surgery.MethodsThis experiment was randomized controlled trial.We chose 90 elective surgical patients（aged 30～75years,ASAⅡ～Ⅲ）for thoracoscope radical resection of lung cancer under double-lumen endotracheal tube intubation combined with general anesthesia.The random number table method was used to divide those patients into 3 groups:the erector spinae plane block group（group E,n=30）,the intercostal nerve block group（group I,n=30）and the control group（group C,n=30）.Nerve block was performed before induction of anesthesia.Patients of group E underwent ultrasound-guided erector spinae plane block at the T₅ level with 0.5%ropivacaine 20ml.Patients of group I underwent ultrasound-guided intercostal nerve block with 0.5%ropivacaine 3ml per intercostal space at the 4,5,6,7,8,9and 10 intercostals.No nerve block was performed on patients of group C.After the operation,the intravenous analgesic pump was connected.The formula was sufentanil250μg added into 0.9%normal saline.The total amount was 300ml and single dose was 2ml.Locking time is 5mins and limited 30ml for 4h.The basic information of patients（age,gender,height,weight,etc）,operation time,anesthesia recovery time,intraoperative analgesics dose（fentanyl,remifentanil,dexmedetomidine）,sufentanil dosage at each time point in 72h after surgery and the use of other remedial analgesics,postoperative adverse reactions（nausea and vomiting,drowsiness,respiratory depression,itchy skin）were reco-rded.ResultsThere was no significant difference in the comparison among the three groups of general data（P>0.05）.Compared with group C,the dosage of fentanyl and remifentanil was reduced in group E and the dosage of remifentanil was reduced in group I,the difference was statistically significant（P<0.05）.The postoperative consumption of sufentanil was significantly lower in group E than in group C at 2,4,6,8,12,24,48 and 72 hours after surgery,the difference was statistically significant（P<0.05）.The postoperative consumption of sufentanil was significantly lower in group I than in group C at 4,6,8,12,24,48 and 72 hours after surgery,the difference was statistically significant（P<0.05）.Compared with group I,the amount of sufentanil used in group E in 72 hours after surgery was reduced,the difference was statistically significant（P<0.05）.There was no significant difference in the number of postoperative remedial analgesic and adverse reactions among the three groups（7）P>0.05（8）.ConclusionThe postoperative analgesic effect of the nerve block combined with the patient controlled intravenous analgesia pump is better.Compared with ultrasound-guided interc-ostal nerve block for thoracoscope radical resection of lung cancer,ultrasound-guided erector spinae plane block has obvious advantage.