关键词: 静脉自控镇痛, 椎旁神经阻滞, 前锯肌平面阻滞, 肺癌, 胸腔镜, 镇痛, 镇静

Abstract: Objective  To explore the effects of three different patient-controlled analgesia protocols on sedation and analgesia in patients undergoing thoracoscopic surgery for lung cancer.Methods  Ninety-three patients undergoing thoracoscopic surgery for lung cancer in our hospital from November 2022 to April 2023 were selected,and randomly assigned into three groups according to different postoperative analgesic protocols.Group P (n=30) was given patient-controlled intravenous analgesia,group T (n=31) received patient-controlled intravenous analgesia combined with thoracic paravertebral block,while group S (n=32) received patient-controlled intravenous analgesia combined with serratus intercostal plane block.Then the Visual Analogue Scale (VAS) score,Ramsay sedation scores,the press times of analgesic pump,the use of sedative drugs and adverse effects were compared among all three groups,and the sensory block plane,performance time,onset time and duration of the block were compared between group T and S.Results  VAS scores in the resting state at postoperative 2h,24h and 48h were (3.09±0.69),(2.83±0.59) and (2.07±0.51) in group P,which were higher than group T[(1.22±0.33),(2.51±0.54) and (1.57±0.45)] and group S[(1.01±0.30),(2.23±0.51) and (1.22±0.25)],group T was higher than group S.VAS scores in the coughing state at postoperative 2h,24h and 48h were (3.63±0.55),(3.24±0.67) and (2.61±0.51) in group P,which were higher than the group T[(1.45±0.29),(2.71±0.56) and (2.33±0.53)] and group S[(1.14±0.28),(2.40±0.57) and (2.03±0.52)],group T was higher than group S.VAS scores in the resting and coughing states at postoperative 2h,24h and 48h yielded statistical difference among three groups (all P<0.05).Ramsay sedation scores at postoperative 2h,24h and 48h were (2.21±0.51),(2.34±0.56) and (2.31±0.55) in group P,(2.23±0.53),(2.35±0.55) and (2.33±0.54) in group T and (2.22±0.52),(2.36±0.57) and (2.32±0.55) in group S,with no statistical difference (all P>0.05).The press times of analgesic pump at postoperative 24h and 48h were (10.18±2.42) and (14.51±3.20) in group P,which were higher than the group T[(3.32±0.79) and (6.84±1.62)] and group S[(1.17±0.28) and (2.63±0.62)],group T was higher than group S,with statistical difference (all P<0.05).The additional dose of sufentanil and the total amount of sufentanil used in postoperative period were (8.05±1.99)μg and (71.53±6.91)μg in group P,which were more than the group T[(3.77±0.93)μg and (65.82±5.77)μg] and the group S[(2.23±0.55)μg and (47.54±4.56)μg],group T was higher than group S,with statistical difference (all P<0.05).Group S had shorter performance time[(5.32±1.77)min] and longer block duration time[(12.51±2.14)h] than those of group T[(12.41±3.42)min and (10.31±2.01)h],with statistical difference(all P<0.05).The incidence of adverse reactions was 6.25% in group S,which was lower than the group P (30.00%,P<0.05),and no statistical difference was reported among three groups in the occurrence rate of comparisons (all P>0.05).Conclusion  The sedation effects of the three different patient-controlled analgesia protocols are comparable,but patient-controlled intravenous analgesia combined with serratus intercostal plane block provides better postoperative analgesia for patients undergoing thoracoscopic surgery for lung cancer,which has less analgesic pump presses and lower dose of postoperative analgesic drugs used,and fewer adverse effects.

Key words: patient-controlled intravenous analgesia, thoracic paravertebral block, serratus intercostal plane block, lung cancer, thoracoscopy, analgesia, sedation