Objective: To investigate the application of ultrasound-guided continuous serratus plane block with patient-controlled analgesia on postoperation analgesia after thoracoscopic surgery, and influence on postoperative rehabilitation. Methods: Sixty patients scheduled for thoracoscopic surgery were randomly divided into two groups. PCNA group (n=30) received ultrasound guided continuous serratus plane block with patient-controlled nerve analgesia, with continuous infusion of 0.2% ropivacaine and 30 ml of 0.3% ropivacaine for the first does. PCIA group(n=30) received patient-controlled intravenous analgesia, with continuous infusion of sufentanil. Postoperative visual analogue scale (VAS) and prince henry pain scale (PHPS) were recorded at 1 hour (T(1)), 4 hour (T(2)), 8 hour (T(3)), 24 hour (T(4)), 2 days (T(5)), 3 days (T(6)), 4 days (T(7)), before discharge (T(8)), 30 days (T(9)) after surgery. Adverse reactions and the time of postoperative first out-of-bed activity, passage of gas by anus, bowel movement, chest tube removal, discharge was also recorded. Results: The resting VAS score of T(3), T(4), T(5) in group PCNA and group PCIA were 0(0) vs 0(2.0), 0(0) vs 2.0(2.0), 0(0) vs 0(2.0), the resting VAS score was lower in group PCNA than in group PCIA (Z=-2.524, -3.944, -3.652, P<0.05 or P<0.01). The upper arm activity VAS score of T(2), T(3), T(4), T(5), T(6), T(7) in group PCNA and group PCIA were 0(0) vs 0(2.0), 0(0) vs 2.0(2.5), 0(2.0) vs 2.0(2.0), 0(2.0) vs 2.0(2.0), 0(0) vs 2.0(2.0), 0(0) vs 0(2.0), the upper arm activity VAS score was lower in group PCNA compared with group PCIA (Z=-2.984, -3.915, -4.484, -4.450, -3.422, -2.456, P<0.05 or P<0.01). The coughing VAS score T(3), T(4), T(5), T(6), T(7) in group PCNA and group PCIA were 2.0(2.0) vs 2.0(2.5), 2.0(2.5) vs 4.0(4.0), 2.0(2.5) vs 4.0(4.0), 2.0(2.0) vs 3.0(2.0), 2.0(2.0) vs 2.0(2.0), the coughing VAS score was lower in group PCNA compared with group PCIA (Z=-3.432, -3.410, -2.643, -3.210, -2.746, P<0.05 or P<0.01). The PHPS score was significantly lower in group PCNA at T(3)[1.0(1.3) vs 2.0(2.0)], T(4)[1.0(2.0) vs 3.0(1.0)], T(5)[1.0(1.3) vs 2.0(1.3)], T(6)[1.0(1.3) vs 2.0(2.0)], T(7)[1.0(1.0) vs 1.0(2.0)] compared to group PCIA (Z=-3.149, -3.662, -3.369, -3.681, -2.815, all P<0.01). And the time of out-of-bed activity, passage of gas by anus of the PCNA group were (20.0± 6.9)h, ( 16.0± 8.0)h, which was advanced more than PCIA group [(23.9± 7.1)h, (34.3± 13.2)h, t=-2.20, -6.47, all P<0.05]. Furthermore, PCNA group had better sleep quality from the 2nd night to the 4th night , and with lower adverse reactions (all P<0.05). Conclusion: The application of ultrasound-guided continuous serratus plane block after thoracoscopic surgery can reduce postoperative pain and enhance recovery after surgery.
目的：探讨超声引导连续前锯肌平面阻滞自控镇痛在胸腔镜手术后的应用及对术后康复的影响。 方法：选取2017年6至8月嘉兴市第一医院择期行胸腔镜下手术患者60例，随机数字表法分为2组(n＝30)：前锯肌平面阻滞自控镇痛组(PCNA组)和静脉自控镇痛组(PCIA组)。术毕，PCNA组行超声引导前锯肌平面阻滞，注入0.3%罗哌卡因30 ml，留置导管予0.2%罗哌卡因行自控镇痛。PCIA组则行舒芬太尼PCIA。记录术后1 h(T(1))、4 h(T(2))、8 h(T(3))、24 h(T(4))、2 d(T(5))、3 d(T(6))、4 d(T(7))、出院前(T(8))、30 d(T(9))视觉模拟评分(VAS)和Prince－Henry疼痛评分(PHPS)。记录首次下床活动、肛门排气、排便、拔胸引管及出院时间。记录不良反应发生情况。 结果： PCNA组静息状态T(3)、T(4)、T(5)时点VAS评分分别为0(0)、0(0)、0(0)分，低于PCIA组的0(2.0)、2.0(2.0)、0(2.0)分，差异均有统计学意义(Z＝－2.524、－3.944、－3.652，P<0.05或P<0.01)。PCNA组上臂活动T(2)～T(7)时点VAS评分分别为0(0)、0(0)、0(2.0)、0(2.0)、0(0)、0(0)分，低于PCIA组的0(2.0)、2.0(2.5)、2.0(2.0)、2.0(2.0)、2.0(2.0)、0(2.0)分，差异均有统计学意义(Z＝－2.984、－3.915、－4.484、－4.450、－3.422、－2.456，P<0.05或P<0.01)。PCNA组咳嗽状态T(3)～T(7)时点VAS评分分别为2.0(2.0)、2.0(2.5)、2.0(2.5)、2.0(2.0)、2.0(2.0)分，低于PCIA组的2.0(2.5)、4.0(4.0)、4.0(4.0)、3.0(2.0)、2.0(2.0)分，差异均有统计学意义(Z＝－3.432、－3.410、－2.643、－3.210、－2.746，P<0.05或P<0.01)。与PCIA组比，PCNA组PHPS评分在T(3)[1.0(1.3)比2.0(2.0)]、T(4)[1.0(2.0)比3.0(1.0)] 、T(5)[1.0(1.3)比2.0(1.3)]、T(6)[1.0(1.3)比2.0(2.0)]、T(7)[1.0(1.0)比1.0(2.0)]更低，差异均有统计学意义(Z＝－3.149、－3.662、－3.369、－3.681、－2.815，均P<0.01)。PCNA组患者术后下床活动时间、肛门排气时间分别为(20.0± 6.9)、(16.0±8.0)h，均早于PCIA组的(23.9± 7.1)、(34.3± 13.2)h，差异均有统计学意义(t＝－2.20、－6.47，均P<0.05)，且术后第2夜、第3夜、第4夜睡眠质量评分更低，不良反应发生率也更低(均P<0.05)。 结论：超声引导前锯肌平面阻滞行自控镇痛能明显减轻胸腔镜手术后疼痛，加快术后康复。.
Keywords: Analgesia, patient-controlled; Nerve block; Rehabilitation; Thoracoscopes; Ultrasonography.