Nagaraja P S, Ragavendran S, Singh Naveen G, Asai Omshubham, Bhavya G, Manjunath N, Rajesh K
Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India.
Department of CTVS, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India.
Ann Card Anaesth. 2018 Jul-Sep;21(3):323-327. doi: 10.4103/aca.ACA_16_18.
Continuous thoracic epidural analgesia (TEA) is compared with erector spinae plane (ESP) block for the perioperative pain management in patients undergoing cardiac surgery for the quality of analgesia, incentive spirometry, ventilator duration, and intensive care unit (ICU) duration.
A prospective, randomized comparative clinical study was conducted. A total of 50 patients were enrolled, who were randomized to either Group A: TEA (n = 25) or Group B: ESP block (n = 25). Visual analog scale (VAS) was recorded in both the groups during rest and cough at the various time intervals postextubation. Both the groups were also compared for incentive spirometry, ventilator, and ICU duration. Statistical analysis was performed using the independent Student's t-test. A value of P < 0.05 was considered statistically significant.
C: omparable VAS scores were revealed at 0 h, 3 h, 6 h, and 12 h (P > 0.05) at rest and during cough in both the groups. Group A had a statistically significant VAS score than Group B (P ≤ 0.05) at 24 h, 36 h, and 48 h but mean VAS in either of the Group was ≤4 both at rest and during cough. Incentive spirometry, ventilator, and ICU duration were comparable between the groups.
ESP block is easy to perform and can serve as a promising alternative to TEA in optimal perioperative pain management in cardiac surgery.
比较连续胸椎硬膜外镇痛（TEA）与竖脊肌平面（ESP）阻滞用于心脏手术患者围手术期疼痛管理时的镇痛质量、激励肺活量测定、机械通气时间及重症监护病房（ICU）住院时间。
进行一项前瞻性、随机对照临床研究。共纳入50例患者，随机分为A组：TEA组（n = 25）和B组：ESP阻滞组（n = 25）。在拔管后的不同时间间隔，记录两组患者休息和咳嗽时的视觉模拟评分（VAS）。同时比较两组患者的激励肺活量测定、机械通气及ICU住院时间。采用独立样本t检验进行统计学分析。P < 0.05为差异有统计学意义。
两组在休息和咳嗽时，0小时、3小时、6小时及12小时的VAS评分相当（P > 0.05）。在24小时、36小时和48小时时，A组的VAS评分显著高于B组（P≤0.05），但两组在休息和咳嗽时的平均VAS均≤4。两组间的激励肺活量测定、机械通气及ICU住院时间相当。
ESP阻滞操作简便，在心脏手术围手术期最佳疼痛管理中可作为TEA的一种有前景的替代方法。
