Sharma Shashikant, Arora Suman, Jafra Anudeep, Singh Gurpreet
Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, India.
Department of Surgery, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, India.
Saudi J Anaesth. 2020 Apr-Jun;14(2):186-191. doi: 10.4103/sja.SJA_625_19. Epub 2020 Mar 5.
The erector spinae plane block is a newer technique of analgesia to the chest wall.
The study was carried out to establish the efficacy and safety of this block in patients undergoing total mastectomy and axillary clearance.
Prospective randomized controlled study.
Single tertiary care center, the study was conducted over a period of 1 year.
65 patients were included; final analysis was done for 60 female patients undergoing total mastectomy and axillary clearance under general anesthesia were randomly allocated to two groups.
Group B (block group) received ultrasound-guided erector spinae plane block at T5 level with ropivacaine (0.5%, 0.4 mL/kg) while the control group did not receive any intervention. Postoperatively, patients in both groups received morphine via intravenous patient-controlled analgesia device. Patients were followed up for 24 h postoperatively.
The 24-hour morphine consumption was considered as the primary outcome and secondary outcomes included time to first rescue analgesia, pain scores at 0, ½, 1, 2, 4, 6, 8, 12, and 24 h and characteristics and complications associated with block procedure.
The 24-hour morphine consumption was 42% lower in block group compared to control group [mean (SD), 2.9 (2.5) mg vs 5.0 (2.1) mg in group B and group C, respectively, = 0.01]. The postoperative pain score was lower in group B vs group C at 0, 1/2, 1, 2, 4, 6, 12, and 24 h ( < 0.05). 26 patients in group C against 14 in group B used rescue analgesia within 1 h of surgery ( = 0.01).
Erector spinae block may prove to be a safe and reliable technique of analgesia for breast surgery. Further studies comparing this technique with other regional techniques are required to identify the most appropriate technique.
竖脊肌平面阻滞是一种用于胸壁镇痛的新技术。
本研究旨在确定该阻滞在接受全乳切除术和腋窝清扫术患者中的有效性和安全性。
前瞻性随机对照研究。
单一的三级医疗中心，研究为期1年。
纳入65例患者；对60例在全身麻醉下接受全乳切除术和腋窝清扫术的女性患者进行最终分析，她们被随机分为两组。
B组（阻滞组）在T5水平接受超声引导下的竖脊肌平面阻滞，使用罗哌卡因（0.5%，0.4 mL/kg），而对照组未接受任何干预。术后，两组患者均通过静脉自控镇痛装置接受吗啡。术后对患者进行24小时随访。
24小时吗啡用量被视为主要观察指标，次要观察指标包括首次补救镇痛时间、0、½、1、2、4、6、8、12和24小时的疼痛评分以及与阻滞操作相关的特征和并发症。
阻滞组24小时吗啡用量比对照组低42%[平均值（标准差），B组和C组分别为2.9（2.5）mg和5.0（2.1）mg，P = 0.01]。B组术后0、½、1、2、4、6、12和24小时的疼痛评分低于C组（P < 0.05）。C组26例患者与B组14例患者在术后1小时内使用了补救镇痛（P = 0.01）。
竖脊肌阻滞可能是一种用于乳腺手术的安全可靠的镇痛技术。需要进一步研究将该技术与其他区域技术进行比较，以确定最合适的技术。
