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竖脊肌平面阻滞与腰方肌阻滞用于小儿下腹部手术的比较:一项双盲、前瞻性、随机试验。

Erector Spinae Plane Block vs Quadratus Lumborum Block for pediatric lower abdominal surgery: A double blinded, prospective, and randomized trial.

机构信息

Department of Anesthesiology and Reanimation, Kocaeli University, Kocaeli, Turkey.

Department of Pediatric Surgery, Kocaeli University, Kocaeli, Turkey.

出版信息

J Clin Anesth. 2019 Nov;57:24-28. doi: 10.1016/j.jclinane.2019.03.006. Epub 2019 Mar 6.

Abstract

STUDY OBJECTIVE

To evaluate and compare the analgesic effect of ultrasound-guided erector spinae plane (ESP) block with ultrasound-guided Quadratus Lumborum Block in pediatric lower abdominal surgeries.

DESIGN

Randomized, prospective, double-blinded trial.

SETTING

Operating room and surgical ward.

PATIENTS

Sixty patients, aged 1 to 7 years with ASA scores of I-II scheduled for elective lower abdominal surgery were included in the study.

INTERVENTIONS

Patients were randomized into two groups as ESPB group and QLB group. Ultrasound guided ESP block at L1 vertebral level was performed preoperatively using 0.5 ml/kg 0.25% bupivacaine (max 20 ml) to the patients in ESPB group. And ultrasound guided QLB block with transmuscular approach was performed preoperatively using 0.5 ml/kg 0.25% bupivacaine (max 20 ml) to the patients in QLB group.

MEASUREMENTS

Face, Legs, Activity, Cry and Consolability (FLACC) scores for pain were recorded at 0, 1, 3 and 6 h postoperatively. Analgesic requirements and time to first analgesic requirement were also recorded.

MAIN RESULTS

Fifty-seven patients were included in the final analyses. No significant difference was determined between the groups' FLACC scores at 0, 1, 3 or 6 h postoperatively (p > 0.05). No significant difference was also determined in times to first analgesia between the groups (p > 0.05).

CONCLUSIONS

This study shows that the ESPB provides similar postoperative analgesia to the QLB in pediatric patients undergoing lower abdominal surgery. Clinicians could decide according to their clinical experiences. CLINICAL TRIALS: https://clinicaltrials.gov/ct2/show/NCT03463382.

摘要

研究目的

评估并比较超声引导竖脊肌平面(ESP)阻滞与超声引导腰方肌阻滞在小儿下腹部手术中的镇痛效果。

设计

随机、前瞻性、双盲试验。

设置

手术室和外科病房。

患者

纳入研究的患者为 60 例年龄 1 至 7 岁、ASA 分级 I-II 级、择期行下腹部手术的患儿。

干预措施

患者随机分为 ESPB 组和 QLB 组。ESPB 组在术前于 L1 椎骨水平行超声引导 ESP 阻滞,使用 0.5ml/kg 0.25%布比卡因(最大 20ml)。QLB 组在术前经肌间入路行超声引导 QLB 阻滞,使用 0.5ml/kg 0.25%布比卡因(最大 20ml)。

测量

术后 0、1、3 和 6 小时记录患儿的面部、腿部、活动、哭闹和安抚(FLACC)疼痛评分。记录镇痛需求和首次镇痛需求时间。

主要结果

最终有 57 例患者纳入了最终分析。术后 0、1、3 或 6 小时两组患者的 FLACC 评分无显著差异(p>0.05)。两组首次镇痛时间也无显著差异(p>0.05)。

结论

本研究表明,ESPB 可为接受下腹部手术的小儿患者提供与 QLB 相似的术后镇痛效果。临床医生可根据自己的临床经验做出决定。临床试验:https://clinicaltrials.gov/ct2/show/NCT03463382。

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