Mariappan Ramamani, Mehta Jigesh, Massicotte Eric, Nagappa Mahesh, Manninen Pirjo, Venkatraghavan Lashmi
Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.
Can J Anaesth. 2015 Aug;62(8):883-90. doi: 10.1007/s12630-015-0382-3. Epub 2015 Apr 14.
Spine surgeries are increasingly being performed as a day or short-stay surgery programs. Peripheral nerve block provide site-specific pain relief with few side effects, thereby reducing surgical stress and enhancing quality of recovery. The aim of our study was to determine the effect of a superficial cervical plexus block (SCPB) on postoperative quality of recovery and analgesia in patients undergoing elective anterior cervical discectomy and fusion (ACDF).
After Research Ethics Board approval, we enrolled adults (> 18 yr) scheduled for elective single- or two-level ACDF in this randomized double-blind clinical trial. Participants were randomized to receive either a SCPB (0.25% bupivacaine, 10 mL) or No Block. The primary outcome measure was the quality of recovery at 24 hr, measured using the 40-item quality of recovery questionnaire (QoR-40). In addition, comparisons between groups were also made for postoperative opioid consumption and discharge times.
Forty-six patients were randomized to receive either a SCPB block (n = 23) or No Block (n = 23). Median [interquartile range] aggregated global QoR-40 scores at 24 hr were significantly greater in the SCPB group, indicating good quality of recovery compared with the No Block group (179 [116-195] vs 157 [97-196], respectively; median difference, 22; 95% confidence interval [CI], 7 to 34; P = 0.002]. There were no differences between the SCPB and the No Block group with regard to mean (standard deviation) postoperative opioid consumption at 24 hr [22.9 (13.6) mg vs 24.6 (9.5) mg, respectively; mean difference 1.7; 95% CI, -5.2 to 8.7; P = 0.620] and the number of patients discharged within 24 hr (15 vs 12, respectively; P = 0.550).
We showed that preoperative SCPB is an effective strategy for improving the early quality of recovery in patients undergoing single- or two-level ACDF. Nevertheless, there was no impact on opioid consumption or discharge times. This trial was registered at www.clinicaltrials.gov (NCT01662219).
脊柱手术越来越多地作为日间或短期住院手术项目开展。外周神经阻滞可提供部位特异性的疼痛缓解，且副作用少，从而减轻手术应激并提高恢复质量。我们研究的目的是确定颈浅丛阻滞（SCPB）对择期颈椎前路椎间盘切除融合术（ACDF）患者术后恢复质量和镇痛的影响。
在获得研究伦理委员会批准后，我们将计划接受择期单节段或双节段ACDF的成年人（>18岁）纳入这项随机双盲临床试验。参与者被随机分为接受SCPB（0.25%布比卡因，10 mL）或不进行阻滞。主要结局指标是术后24小时的恢复质量，使用40项恢复质量问卷（QoR-40）进行测量。此外，还对两组之间的术后阿片类药物消耗量和出院时间进行了比较。
46例患者被随机分为接受SCPB阻滞组（n = 23）或不阻滞组（n = 23）。SCPB组术后24小时的中位[四分位间距]综合总体QoR-40评分显著更高，表明与不阻滞组相比恢复质量良好（分别为179 [116 - 195]和157 [97 - 196]；中位差值为22；95%置信区间[CI]，7至34；P = 0.002）。SCPB组和不阻滞组在术后24小时的平均（标准差）阿片类药物消耗量方面无差异[分别为22.9（13.6）mg和24.6（9.5）mg；平均差值1.7；95% CI，-5.2至8.7；P = 0.620]，以及24小时内出院的患者数量方面也无差异（分别为15例和12例；P = 0.550）。
我们表明术前SCPB是改善接受单节段或双节段ACDF患者早期恢复质量的有效策略。然而，对阿片类药物消耗量或出院时间没有影响。本试验已在www.clinicaltrials.gov（NCT01662219）注册。
