接受二尖瓣/三尖瓣修复手术的患者中竖脊肌平面阻滞和胸神经阻滞用于术后疼痛治疗的随机对照试验。
Postoperative pain treatment with erector spinae plane block and pectoralis nerve blocks in patients undergoing mitral/tricuspid valve repair - a randomized controlled trial.
机构信息
Division of Cardiovascular Surgery, St. Jadwiga Provincial Clinical Hospital, ul. Lwowska 60, 35-301, Rzeszów, Poland.
Second Department of Anesthesia and Intensive Care, Medical University of Lublin, ul. Staszica 16, 20-081, Lublin, Poland.
出版信息
BMC Anesthesiol. 2020 Feb 27;20(1):51. doi: 10.1186/s12871-020-00961-8.
BACKGROUND
Effective postoperative pain control remains a challenge for patients undergoing cardiac surgery. Novel regional blocks may improve pain management for such patients and can shorten their length of stay in the hospital. To compare postoperative pain intensity in patients undergoing cardiac surgery with either erector spinae plane (ESP) block or combined ESP and pectoralis nerve (PECS) blocks.
METHODS
This was a prospective, randomized, controlled, double-blinded study done in a tertiary hospital. Thirty patients undergoing mitral/tricuspid valve repair via mini-thoracotomy were included. Patients were randomly allocated to one of two groups: ESP or PECS + ESP group (1:1 randomization). Patients in both groups received a single-shot, ultrasound-guided ESP block. Participants in PECS + ESP group received additional PECS blocks. Each patient had to be extubated within 2 h from the end of the surgery. Pain was treated via a patient-controlled analgesia (PCA) pump. The primary outcome was the total oxycodone consumption via PCA during the first postoperative day. The secondary outcomes included pain intensity measured on the visual analog scale (VAS), patient satisfaction, Prince Henry Hospital Pain Score (PHHPS), and spirometry.
RESULTS
Patients in the PECS + ESP group used significantly less oxycodone than those in the ESP group: median 12 [interquartile range (IQR): 6-16] mg vs. 20 [IQR: 18-29] mg (p = 0.0004). Moreover, pain intensity was significantly lower in the PECS + ESP group at each of the five measurements during the first postoperative day. Patients in the PECS + ESP group were more satisfied with pain management. No difference was noticed between both groups in PHHPS and spirometry.
CONCLUSIONS
The addition of PECS blocks to ESP reduced consumption of oxycodone via PCA, reduced pain intensity on the VAS, and increased patient satisfaction with pain management in patients undergoing mitral/tricuspid valve repair via mini-thoracotomy.
TRIAL REGISTRATION
The study was registered on the 19th July 2018 (first posted) on the ClinicalTrials.gov identifier: NCT03592485.
背景
对于接受心脏手术的患者来说，有效的术后疼痛控制仍然是一个挑战。新型区域阻滞技术可能改善此类患者的疼痛管理，并缩短其住院时间。本研究旨在比较心脏手术患者接受竖脊肌平面（ESP）阻滞或 ESP 联合胸长神经（PECS）阻滞的术后疼痛强度。
方法
这是一项在一家三级医院进行的前瞻性、随机、对照、双盲研究。共纳入 30 例行微创小切口二尖瓣/三尖瓣修复术的患者。患者随机分配至 ESP 组或 PECS + ESP 组（1:1 随机分组）。两组患者均接受单次超声引导下 ESP 阻滞。PECS + ESP 组患者还接受了 PECS 阻滞。每组患者均需在手术结束后 2 小时内拔管。疼痛通过患者自控镇痛（PCA）泵进行治疗。主要结局是术后第 1 天通过 PCA 消耗的总羟考酮量。次要结局包括视觉模拟评分（VAS）测量的疼痛强度、患者满意度、亨利亲王医院疼痛评分（PHHPS）和肺活量测定。
结果
PECS + ESP 组患者使用的羟考酮明显少于 ESP 组：中位数 12 [四分位距（IQR）：6-16] mg 比 20 [IQR：18-29] mg（p = 0.0004）。此外，在术后第 1 天的 5 次测量中，PECS + ESP 组的疼痛强度均显著低于 ESP 组。PECS + ESP 组患者对疼痛管理的满意度更高。两组患者的 PHHPS 和肺活量测定均无差异。
结论
在微创小切口二尖瓣/三尖瓣修复术中，PECS 阻滞联合 ESP 阻滞可减少 PCA 消耗的羟考酮量、降低 VAS 疼痛评分，并增加患者对疼痛管理的满意度。
试验注册
该研究于 2018 年 7 月 19 日在 ClinicalTrials.gov 上注册（首次发布），注册号为：NCT03592485。
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