Taketa Yasuko, Irisawa Yumi, Fujitani Taro
Department of Anesthesiology and Critical Care, Ehime Prefectural Central Hospital, Matsuyama, Japan
Department of Anesthesiology and Critical Care, Ehime Prefectural Central Hospital, Matsuyama, Japan.
Reg Anesth Pain Med. 2019 Nov 8. doi: 10.1136/rapm-2019-100827.
The anesthetic characteristics of ultrasound-guided erector spinae plane block (ESPB) remain unclear. We compared the analgesic efficacies of ESPB and thoracic paravertebral block (TPVB) for analgesia after video-assisted thoracic surgery (VATS).
In this prospective randomized non-inferiority trial, 88 patients undergoing VATS randomly received ESPB or TPVB. All patients received continuous infusion of 0.2% levobupivacaine (8 mL/hour) after injection of a 20 mL 0.2% levobupivacaine bolus. The primary outcome was median differences between the groups in postoperative numerical rating scale (NRS) scores at rest, 24 hours postoperatively.
Eighty-one patients completed the study. The median difference in NRS scores at rest 24 hours postoperatively was 1 (range 0-1), demonstrating the non-inferiority of ESPB to TPVB. NRS scores at rest were significantly lower in the TPVB group at 1, 2 and 24 hours postoperatively (p=0.02, 0.01 and 0.006, respectively). NRS scores on movement were similar. More dermatomes in parasternal regions were anaesthetized in the TPVB group (p<0.0001). Total plasma levobupivacaine concentrations were significantly lower in the ESPB group within 20 hours postoperatively (p=0.036).
The analgesic effect of ESPB after VATS was non-inferior to that of TPVB 24 hours postoperatively.
UMIN000030658.
超声引导下竖脊肌平面阻滞（ESPB）的麻醉特性尚不清楚。我们比较了ESPB和胸椎旁神经阻滞（TPVB）用于电视辅助胸腔镜手术（VATS）后镇痛的效果。
在这项前瞻性随机非劣效性试验中，88例行VATS的患者随机接受ESPB或TPVB。所有患者在注射20mL 0.2%左旋布比卡因负荷量后，持续输注0.2%左旋布比卡因（8mL/小时）。主要结局是术后24小时静息状态下两组数字评分量表（NRS）得分的中位数差异。
81例患者完成了研究。术后24小时静息状态下NRS得分的中位数差异为1（范围0 - 1），表明ESPB不劣于TPVB。术后1、2和24小时，TPVB组静息状态下的NRS得分显著更低（分别为p = 0.02、0.01和0.006）。活动时的NRS得分相似。TPVB组胸骨旁区域麻醉的皮节更多（p < 0.0001）。术后20小时内，ESPB组的血浆左旋布比卡因总浓度显著更低（p = 0.036）。
VATS后ESPB的镇痛效果在术后24小时不劣于TPVB。
UMIN000030658。
