Journal of Hebei Medical University ›› 2021, Vol. 42 ›› Issue (11): 1312-1316.doi: 10.3969/j.issn.1007-3205.2021.11.015

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Modified strategy of anesthesia for thoracoscopic pulmonary bullae resection: ultrasound-guided rhomboid intercostal and subserratus plane block combined with general anesthesia

  

  1. 1.Department of Anesthesiology, People′s Hospital of Jieyang City, Guangdong Province, Jieyang 
    522000, China; 2.Graduate School of Youjiang Medical College for Nationalities, Guangxi Province, 
    Baise 533000, China; 3.Department of Cardiothoracic Surgery, People′s Hospital of Jieyang City, 
    Guangdong Province, Jieyang 522000, China; 4.Clinical Medical Research Laboratory, 
    People′s Hospital of Jieyang City, Guangdong Province, Jieyang 522000, China
  • Online:2021-11-25 Published:2021-11-29

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Abstract: Objective A total of 70 patients of either gender, aged 18-60 years, with American Society of Anesthesiologists（ASA） grade Ⅰ or Ⅱ, were selected for elective thoracoscopic pulmonary bullae resection. 
Methods They were randomly divided into block combined with general anesthesia group (group R) and simple general anesthesia group (group G),with 35 cases in each group.Group R received rhomboid intercostal and subserratus plane block (RISS) block before anesthesia induction, while group G did not receive intervention. Patients in two groups were given general anesthesia through bronchial intubation and patient-controlled intravenous analgesia (PCIA) after operation. The visual analogue scale(VAS)scores for pain at rest and during coughing at 2, 6, 12, 24 and 48 h after operation were recorded. The total amount of propofol and remifentanil used during the operation were recorded.The times of pressing the analgesia pump, the total amount of sufentanil, the number of cases of flurbiprofen axetil remedial analgesia and the score of analgesia satisfaction were recorded. The incidence of adverse reactions including pruritus, nausea and vomiting, and vertigo were recorded within 48 h after operation. 
Results The VAS scores for pain at rest and during cough of the two groups were gradually increased and then decreased at each time point after operation, and the increase amplitude of group R was significantly less than that of group G. The differences of interaction between groups, time points and time points between groups were statistically significant(P＜0.05). The total amount of propofol and remifentanil used in group R was significantly lower than that in group G(P＜0.05). The number of times of pressing, total amount of sufentanil and the number of flurbiprofen axetil analgesia in group R were significantly lower than those in group G(P＜0.05), and the score of satisfaction with analgesia was significantly higher than that in group G(P＜0.05). 
Conclusion Ultrasound-guided rhomboid, intercostal and subserratus plane block combined with general anesthesia for thoracoscopic pulmonary bullae resection can provide good postoperative analgesia, reduce the use of perioperative sedative and analgesic drugs, and improve the satisfaction of analgesia.


Key words: pneumothorax, thoracoscopic bullae resection, rhomboid, intercostal and subserratus plane block