超声引导下竖脊肌平面阻滞在腹壁疝修补术患者的应用:前瞻性随机对照研究
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Ultrasound-Guided Erector Spinae Plane Block in Patients Undergoing Open Epigastric Hernia Repair: A Prospective Randomized Controlled Study
背景与目的
疝修补术患者术后伴随着严重的术后疼痛。我们研究了双侧超声引导下竖脊肌平面阻滞在中线开腹腹疝修补术患者中的镇痛效果。
方 法
将60例年龄18~65岁患者随机分为2组。竖脊肌平面阻滞组患者在T7横突水平采用双侧超声引导下双侧竖脊肌平面阻滞，每侧用0.25%布比卡因20mL，对照组用1mL生理盐水行双侧假直立竖脊肌平面阻滞。所有患者均接受全身麻醉手术。术后24小时内记录疼痛程度(视觉模拟评分)、术中芬太尼用量、首次请求追加镇痛的时间和术后哌替啶用量。
结 果
术后2小时，竖脊肌平面阻滞组的视觉模拟量表疼痛评分明显低于对照组(估计主效应为2.53；P˂0.001；95%CI(1.8-3.2)，并在术后12小时内保持较低水平(从进入麻醉恢复室到术后4小时P˂0.001，6小时为.001,8小时为.025,12小时为.043)。在第18和24小时，两组视觉模拟量表疼痛评分无显著差异(P =0 .634和0.432)。竖脊肌平面阻滞组中有4例患者术中需要芬太尼，而对照组有27例患者。与对照组(94μg[74-130μg])相比，竖脊肌平面阻滞组术中芬太尼消耗量的中位数(四分位数)显著降低(0μg[0-0μg])。竖脊肌平面阻滞组中有10例患者术后需要追加哌替啶，而对照组为25例。与对照组(83 mg[64-109 mg])相比，竖脊肌平面阻滞组术后追加哌替啶消耗量的中位数[四分位数](0 mg[0-33 mg])明显低于对照组(0 mg[0-33 mg])。与对照组相比，竖脊肌平面阻滞组首次请求需要追加止痛的时间显著延长(P<0.001)。
结 论
超声引导下双侧竖脊肌平面阻滞降低了手术后视觉模拟评分，减少了术中芬太尼和术后追加镇痛药物的消耗。
原始文献摘要
BACKGROUND: Hernia repair is associated with considerable postoperative pain. We studied the analgesic efficacy of bilateral ultrasound-guided erector spinae plane block in patients undergoing open midline epigastric hernia repair (T6–T9).
METHODS: Sixty patients 18–65 years of age were randomly allocated into 2 groups. Patients in the erector spinae plane block group received bilateral ultrasound-guided erector spinae plane block at the level of T7 transverse process using 20 mL of bupivacaine 0.25% on each side, while the control group received bilateral sham erector spinae plane block using 1 mL of normal saline. All patients underwent general anesthesia for surgery. Pain severity (visual analog scale), consumption of intraoperative fentanyl, time to first request of rescue analgesia, and postoperative pethidine consumption were recorded over the first 24 hours postoperatively.
RESULTS: At 2 hours postoperatively, the visual analog scale pain score was significantly lower in the erector spinae plane block group compared to the control group (estimated main effect of 2.53; P ˂ .001; 95% CI, 1.8–3.2) and remained lower until 12 hours postoperatively (P < .001 from postanesthesia care unit admission to 4 hours postoperatively, .001 at 6 hours, .025 at 8 hours, and .043 at 12 hours). At 18 and 24 hours, visual analog scale pain scores were not significantly different between both groups (P = .634 and .432, respectively). Four patients in the erector spinae plane block group required intraoperative fentanyl compared to 27 patients in control group. The median (quartiles) of intraoperative fentanyl consumption in the erector spinae plane block group was significantly lower (0 μg [0–0 μg]) compared to that of the control group (94 μg [74–130 μg]). Ten patients in the erector spinae plane block group required postoperative rescue pethidine compared to 25 patients in control group. The median [quartiles] of postoperative rescue pethidine consumption was significantly lower in the erector spinae plane block group (0 mg [0–33 mg]) compared to that of the control group (83 mg [64–109 mg]). Time to first rescue analgesic request was significantly prolonged in the erector spinae plane block group compared to control group (P < .001).
CONCLUSIONS: Ultrasound-guided bilateral erector spinae plane block provided lower postoperative visual analog scale pain scores and decreased consumption of both intraoperative fentanyl and postoperative rescue analgesia for patients undergoing open epigastric hernia repair.
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贵州医科大学高鸿教授课题组
翻译：余晓旭 编辑：何幼芹 审校：王贵龙