Abstract: Objective To investigate the effectiveness and safety of ultrasound-guided erector spinae plane block (ESPB) combined with oxycodone patient controlled intravenous analgesia (PCIA) for postoperative analgesia in patients undergoing laparoscopic cholecystectomy (LC). Methods A total of 58 patients underwent laparoscopic cholecystectomy under general anesthesia, including 22 males and 36 females, with ASA I or II, they were randomly divided into two groups: single ESPB combined with PCIA group (group EP) and simple PCIA group (Group P). Patients in the group EP received ultrasound-guided ESPB before induction of anesthesia. Both groups were evaluated according to the numerical rating scale (NRS). When the NRS score was ≥4 points, oxycodone titration was administered intravenously until the NRS score was <4 points and then PCIA was used. Postoperative oxycodone titration; NRS scores before titration, at the end of titration, 1 h, 4 h, 8 h, 12 h, 16 h, 24 h later at rest and cough; the dose of oxycodone within 0~4 h, 4~8 h, 8~12 h, 12~16 h, and 16~24 h after surgery; the number of effective press of analgesic pump within 0~4 h, 4~8 h, 8~12 h, 12~16 h, and 16~24 h after surgery; the number of postoperative remedial analgesia and postoperative adverse reactions in the two groups were recorded. Results The postoperative titrated oxycodone dosage and the PCIA oxycodone dosage with 0~4 h and 4~8 h after surgery of the group EP were significantly less than those of the group P [0.0 (1.0, 2.0) mg vs.2.0 (0.0, 4.0) mg, 0.4 (0.4, 1.4) mg vs.0.4 (0.4, 1.4) mg, 0.4 (0.4, 0.4) mg vs.0.4 (1.4, 2.4) mg] (all P<0.05). The NRS scores at 1 hour after surgery at rest and cough in the group EP were significantly lower than those in the group P [(1.38±0.86) points vs.(1.92±0.83) points, (1.93±0.80) points vs.(2.50±0.59) points] (both P<0.05); the NRS scores at 4 hours after surgery at rest and cough in the group EP were significantly lower than those in the group P [(1.21±0.68) points vs.(1.71±0.69) points, (1.90±0.62) points vs.(2.29±0.69) points] (both P<0.05); the NRS scores at 8 hours after surgery at rest and cough in the group EP were significantly lower than those in the group P [(1.41±0.73) points vs.(2.00±0.59) points, (1.66±0.67) points vs.(2.21±0.83) points] (both P<0.01). The number of effective press of analgesic pump within 0~4 h and 4~8 h after surgery in the group EP were significantly lower than those in the group P [0.4 (0.4, 1.4) times vs.1.4 (0.4, 3.1) times, 0.4 (0.4, 0.4) times vs.1.4 (0.4, 2.4) times] (both P<0.05). Conclusion Ultrasound-guided ESPB can significantly reduce the PCIA dosage of oxycodone after LC, which is a safe and effective way of analgesia.

Key words: Ultrasonic guidance, Erector spinae plane block (ESPB), Laparoscopic cholecystectomy (LC), Postoperative analgesia

摘要： 目的 探讨超声引导下竖脊肌平面阻滞(ESPB)对腹腔镜胆囊切除术(LC)后羟考酮自控静脉镇痛(PCIA)有效性与安全性的影响。方法 选择2019年3—5月择期在全麻下行LC患者58例,男22例,女36例,ASA分级Ⅰ或Ⅱ级,随机分成两组:单次ESPB联合PCIA组(EP组)和单纯PCIA组(P组)。EP组麻醉诱导前行ESPB,术毕两组均根据疼痛数字评分法(NRS)评测疼痛程度,当NRS评分≥4分,静脉给予羟考酮滴定直至NRS评分<4分后采用PCIA。记录术后两组患者羟考酮滴定量;滴定前、滴定完成时、1 h、4 h、8 h、12 h、16 h、24 h的静息和咳嗽时NRS评分;术后0~4 h、4~8 h、8~12 h、12~16 h、16~24 h羟考酮用量;术后0~4 h、4~8 h、8~12 h、12~16 h、16~24 h镇痛泵的有效按压次数;术后补救镇痛次数及术后不良反应发生情况。结果 EP组术后滴定的羟考酮用量、术后0~4 h及4~8 h的PCIA羟考酮用量均明显少于P组,分别为0.0(1.0,2.0)mg比2.0(0.0,4.0)mg、0.4(0.4,1.4)mg比0.4(0.4,1.4)mg、0.4(0.4,0.4)mg比0.4(1.4,2.4)mg(均P<0.05)。EP组术后1 h静息和咳嗽时NRS评分显著低于P组,分别为(1.38±0.86)分比(1.92±0.83)分、(1.93±0.80)分比(2.50±0.59)分(均P<0.05);EP组术后4 h静息和咳嗽时NRS评分显著低于P组,分别为(1.21±0.68)分比(1.71±0.69)分、(1.90±0.62)分比(2.29±0.69)分(均P<0.05);EP组术后8 h静息和咳嗽时NRS评分显著低于P组,分别为(1.41±0.73)分比(2.00±0.59)分、(1.66±0.67)分比(2.21±0.83)分(均P<0.01)。EP组术后0~4 h及4~8 h内镇痛泵的有效按压次数显著少于P组,分别为0.4(0.4,1.4)次比1.4(0.4,3.1)次、0.4(0.4,0.4)次比1.4(0.4,2.4)次(均P<0.05)。结论 超声引导下ESPB可以显著减少LC术后羟考酮PCIA用量,是一种安全有效的镇痛方式。

关键词: 超声引导, 竖脊肌平面阻滞, 腹腔镜胆囊切除手术, 术后镇痛