食管疾病2026，Vol.8Issue(2)：118-124,7.DOI:10.15926/j.cnki.issn2096-7381.2026.02.004
超声辅助肋缘下腹横肌平面联合腹直肌鞘阻滞在胸腹腔镜食管癌手术中的优势
Advantages of Ultrasound-Guided Subcostal Transversus Abdominis Plane Block Combined with Rectus Sheath Block in Thoracoscopic-Laparoscopic Esophagectomy
摘要
Abstract
Objective To investigate the analgesic efficacy of ultrasound-assisted subcostal transversus abdominis plane block(OTAPB)combined with rectus sheath block(RSB)for postoperative pain management in patients undergoing thoracoscopic-laparoscopic esophagectomy of esophageal cancer(EC).Methods 80 patients scheduled for elective thoracoscopic and laparoscopic esophagectomy at Anyang Cancer Hospital between November 2023 and May 2024 were prospectively randomized into two groups:the TP group(ultrasound-guided thoracic paravertebral block combined with general anesthesia,n=40)and the OR group(ultrasound-guided oblique subcostal transversus abdominis plane block combined with rectus sheath block and general anesthesia,n=40).Both groups underwent nerve block procedures after anesthesia induction,using 40 mL of 0.25%ropivacaine.Postoperatively,patient-controlled intravenous analgesia was provided to all patients.Primary outcomes included:visual analogue scale(VAS)scores at rest and during cough at 2 h,4 h,8 h,12 h,18 h,and 24 h postoperatively;number of PCA presses and rescue analgesia requirements within 24 h;and duration of nerve block procedure.Secondary outcomes included:MAP,HR,and PPI at predefined timepoints,surgical site,duration,intraoperative opioid and vasopressor use,and complications related to nerve block(hematoma,local anesthetic toxicity,infection)within 24 h postoperatively.Results Compared with the TP group,the OR group had significantly fewer PCA presses(P<0.05)and lower rescue analgesia requirements(P<0.05)within 24 h postoperatively.Additionally,the OR group demonstrated lower VAS scores at rest(4 h,8 h,12 h,18 h)and during cough(2 h,4 h,8 h,12 h,18 h)(P<0.05).The duration of the nerve block procedure was also shorter in the OR group(P<0.05).Conclusion Ultrasound-guided OTAPB+RSB is a more convenient technique that effectively manages postoperative abdominal incisional pain in patients undergoing thoracoscopic and laparoscopic esophagectomy,reducing postoperative pain scores.关键词
超声引导/肋缘下腹横肌平面阻滞/腹直肌鞘阻滞/胸椎旁阻滞/食管癌手术/VAS评分Key words
ultrasound guidance/subcostal transversus abdominis plane block/rectus sheath block/thoracic paravertebral block/esophagectomy/VAS score分类
医药卫生引用本文复制引用
刘杰,侯一凡,韩学宾..超声辅助肋缘下腹横肌平面联合腹直肌鞘阻滞在胸腹腔镜食管癌手术中的优势[J].食管疾病,2026,8(2):118-124,7.基金项目
安阳市2023科技发展计划(重点研发与推广)项目(2023C01SF009) （重点研发与推广）
