Effect of Ultrasound-guided Single Erector Spinalis Plane Block on Analgesia, Inflammatory and Immune Indexes of Pulmonary Lobectomy Under Da Vinci Operation
ZHANG Qun-qing, XU Xiang-zhao, LI Jing, et al
The Second Department of Imaging, Shaanxi Provincial Rehabilitation Hospital, Xi'an 710005
Abstract：【Objective】 To investigate the analgesic effect of single erector spinae plane (ESP) block under ultrasound-guided Da Vinci robotic surgery for patients undergoing lower lobectomy and its effect on inflammatory factors and immune function. 【Methods】 A total of 80 patients who underwent Da Vinci robotic surgery for lower lobectomy was divided into an observation group and a control group, with 40 people in each group by the random number table method. The observation group underwent single ultrasound-guided ESP block before anesthesia induction, and the control group received ultrasound-guided paravertebral nerve block (TPVB) before anesthesia induction.The two groups used patient-controlled intravenous analgesia (PCIA) after operation.The visual simulation method (VAS) was used to evaluate pain score in the rest and cough at the time of extubation (T1), 6h after surgery (T2), 18h after surgery (T3), 24h after surgery (T4) and 48h after surgery (T5).The number of patients getting out of bed cases within 24 hours and the number of PCIA compress-ions within 48 hours after operation were counted.The fasting venous blood of the patients was collected in the morning 24 hours after operation, and the inflammatory factors (IL-6, IL-8, CRP, TNF-α) and immune function indicators (IgG,IgA,IgM) were detected by Enzyme-Linked Immunosorbent Assays (ELISA). 【Results】 Patients in the observation group had lower pain scores in the resting and cough during extubation (T1), 6h (T2), 18h (T3), 24h (T4) and 48h (T5) after surgery(P<0.05).The rate of getting out of bed cases in the observation group was 82.5%, which was higher than that in the control group 62.5%. The difference between the two groups was statistically significant (P<0.05).The number of PCIA compressions in the observation group was lower than that in the control group (P<0.05).The levels of inflammatory factors IL-6, IL-8, CRP, and TNF-α in the observation group were lower than those in the control group (P<0.05).The serum IgG, IgA and IgM immune indexes of observation group were higher than those of control group at 24h after operation (P<0.05). 【Conclusion】 Robot-assisted thoracoscopic lobectomy patients with ultrasound-guided single ESPB have better analgesic effects than TPVB, and postoperative inflammation symptoms are mild, indicating that ESPB has stronger immune function compared with TPVB.
张群青, 徐向钊, 李静, 单兆亚. 超声引导下单次竖脊肌平面阻滞对达芬奇辅助胸腔镜肺叶切除患者镇痛、炎性及免疫指标的影响[J]. 医学临床研究, 2021, 38(4): 515-518.
ZHANG Qun-qing, XU Xiang-zhao, LI Jing, et al. Effect of Ultrasound-guided Single Erector Spinalis Plane Block on Analgesia, Inflammatory and Immune Indexes of Pulmonary Lobectomy Under Da Vinci Operation. JOURNAL OF CLINICAL RESEARCH, 2021, 38(4): 515-518.
[1] SONG Y,HAN B,LEI W,et al. Low concentrations of lidocaine for inguinal hernia repair under local infiltration anaesthesia[J].J Int Med Res,2013,41(2):371-377. [2] NANDHAKUMAR A,NAIR A,BHARATH V K,et al.Erector spinae plane block may aid weaning from mechanicalventilation in patients with multiple rib fracturs: case report of two cases[J].Indian J Anaesth,2018,62(2):139-141. [3] KARCA O,PINRHU.Efficay of ultrasound-guided bilateralerector spinae plane block in pediatric laparoscopic cholecystectomy:Case series[J].J Turkish Soc Algol,2019,31(4): 209-213. [4] 王甜.竖脊肌平面阻滞的临床应用研究进展[J].中国微创外科杂志,2018,10 (18):927-930. [5] CUNNINGHAM J,TEMPLE W J,MITCHELL P,et al. Cooperative hernia study. Pain in the postrepair patient[J].Ann Surg,1996,224(5):598-602. [6] VAN HANSWIJCK DE JONGE P,LLOYD A,HORSFALL L,et al. The measurement of chronic pain and health related quality of life following inguinal hernia repair:a review of the literature[J].Hernia,2008,12(6):561-569. [7] KULACOGLU H,OZYAYLALI I,YAZICIOGLU D. Factors determining the doses of local anesthetic agents in unilateral inguinal hernia repair[J].Hernia,2009,13(5):511-516. [8] 马丹旭,任惠龙,芮燕,等.超声引导下单次竖脊肌平面阻滞对胸腔镜下肺叶切除患者静脉自控镇痛效果的影响[J].临床麻醉学杂志,2017,33(10):963-967. [9] 郅娟,杨冬,晏馥霞,等.超声引导下竖脊肌阻滞在围手术期镇痛中的应用[J].医学综述,2019,25(21):4296-4300. [10] FORERO M,ADHIKARY S D,LOPEZ H,et al.The erector spinae plane block: a novel analgesic technique inthoracic neuropathic pain[J].Reg Anesth Pain Med,2016,41( 5) : 621-627. [11] CHIN K J,MALHAS L,PERLAS A.The erector spinae plane block provides visceral abdominal analgesia in bariatric surgery: A report of 3 cases[J].Reg Anesth Pain Med,2017,42(3):372-376. [12] MAZZEFFIM,MAROTTA M,LINH M,et al.Duration of deephypothermia during aortic surgery and the risk of periopertive blood transfusion[J].Ann Card Anaesth,2012,15(4):266-273. [13] 李剑涛,黄佳,林皓,等.单中心连续333例机器人辅助胸腔镜肺叶切除术治疗Ⅰ期非小细胞肺癌[J].中国胸心血管外科临床杂志,2017,24(11):825-829. [14] 李孝争,刘美荣,李国振,等.竖脊肌阻滞和椎旁神经阻滞用于胸腔镜下肺叶切除术术后镇痛的比较[J].中外医疗,2019,38(23):50-52. [15] 汪俊恺,何莹,陈悦,等.超声引导下竖脊肌平面阻滞在胸腔镜肺癌根治术术后镇痛中的应用[J].浙江医学,2018,40(20):2268-2270. [16] 黄少先,李卓毅,陈立强,等.胸腔镜下肺叶切除术治疗非小细胞肺癌的临床分析[J].中国医药学,2012,2(2):57-58. [17] WAKELEE H A,DAHLBERG S E,BRAHMER J R,et al. Differential effect of age on survival in advanced NSCLC in women versus men: analysis of recent Eastern Cooperative Oncology Group ( ECOG) studies,with and without bevacizumab[J].Lung Cancer,2012,76(3):410-415. [18] 郭建峰,李喆,许瑞彬.支气管袖状切除术与全肺切除术治疗老年非小细胞肺癌临床疗效对比研究[J].解放军医药杂志,2016,28(6):41-44. [19] 袁世璋,杜小军.肺癌根治性袖状切除术和全肺切除术治疗非小细胞肺癌的比较研究[J].中国现代医学杂志,2014,24(36):94-96.
2021, Vol. 38 
