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竖脊肌平面阻滞对腹腔镜胆囊切除术麻醉的影响:阿片类药物用量、七氟醚用量及成本分析

The Effect of Erector Spinae Plane Block on Laparoscopic Cholecystectomy Anesthesia: Analysis of Opioid Consumption, Sevoflurane Consumption, and Cost.

作者信息

Peker Kevser, Akçaboy Zeynep Nur, Aydın Gülçin, Gençay Işın, Şahin Ahmet Tuğrul, Koçak Yahya Fatih, Peker Seydi Ali

机构信息

Anesthesiology and Critical Care, Kırıkkale University Medical Faculty Hospital, Kırıkkale, Turkey.

Medical Biochemistry, Kırıkkale Yuksek Ihtisas Hospital, Kırıkkale, Turkey.

出版信息

J Laparoendosc Adv Surg Tech A. 2020 Jul;30(7):725-729. doi: 10.1089/lap.2019.0809. Epub 2020 Feb 5.

Abstract

Erector spinae plane (ESP) block has been increasingly suggested for laparoscopic cholecystectomy (LC) as a part of multimodal analgesia in many studies. However, there is not any study that investigated the perioperative effects of ESP block on anesthetic agent consumption and cost of LC anesthesia. This is the first study that evaluates the effect of ESP block in terms of cost-effectiveness, intraoperative consumption of inhalation agents, and perioperative consumption of opioids. In this prospective observational study, 81 patients who underwent LC were included. Patients were divided into two groups: In Group ESP ( = 39) bilateral ultrasound-guided ESP block was performed in preoperative period and in Group non-ESP ( = 42) ESP block was not performed. After standard general anesthesia protocol, anesthesia was maintained with 2% sevoflurane in 50% air and 50% oxygen with controlled ventilation in both groups. All patients were monitored with electrocardiography, noninvasive blood pressure, pulse oximetry, end-tidal carbon dioxide, and bispectral index. The consumption of sevoflurane and opioids in the intraoperative and postoperative 24 hours was recorded. The costs of drugs were determined by multiplying total consumed amounts with unit prices. The costs and the consumed amounts of remifentanyl, sevoflurane, and tramadol were significantly higher in non-ESP group in the perioperative period (respectively,  < .001,  = .01, and  < .001). ESP block for LC decreased the consumed amount and cost of inhaled agents and opioids in the perioperative period.

摘要

在许多研究中,竖脊肌平面(ESP)阻滞作为多模式镇痛的一部分,越来越多地被推荐用于腹腔镜胆囊切除术(LC)。然而,尚无任何研究调查ESP阻滞对LC麻醉中麻醉药物消耗量和成本的围手术期影响。这是第一项从成本效益、术中吸入药物消耗量和围手术期阿片类药物消耗量方面评估ESP阻滞效果的研究。在这项前瞻性观察研究中,纳入了81例行LC的患者。患者分为两组:ESP组(n = 39)在术前进行双侧超声引导下的ESP阻滞,非ESP组(n = 42)未进行ESP阻滞。按照标准全身麻醉方案,两组均采用2%七氟醚、50%空气和50%氧气维持麻醉,并进行控制通气。所有患者均接受心电图、无创血压、脉搏血氧饱和度、呼气末二氧化碳和脑电双频指数监测。记录术中及术后24小时七氟醚和阿片类药物的消耗量。药物成本通过将总消耗量乘以单价来确定。围手术期,非ESP组瑞芬太尼、七氟醚和曲马多的成本和消耗量显著更高(分别为P <.001、P = .01和P <.001)。LC的ESP阻滞降低了围手术期吸入药物和阿片类药物的消耗量及成本。

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