Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, 05505, Korea.
Sci Rep. 2020 May 21;10(1):8389. doi: 10.1038/s41598-020-65172-0.
The visceral analgesic efficacy of erector spinae plane block (ESPB) is still a matter of debate. This study attempted to investigate the visceral analgesic efficacy of ESPB in clinical setting. After randomized, we performed ultrasound-guided bilateral rectus sheath block (RSB), which was aimed to prevent postoperative somatic pain on all patients who underwent laparoscopic cholecystectomy (LC). Ultrasound-guided bilateral ESPB at T7 level was performed only to the intervention group to provide the visceral analgesic block. The intraoperative requirement for remifentanil (P = 0.021) and the cumulative fentanyl consumption at postoperative 24-hours was significantly lower in the ESPB group (206.5 ± 82.8 μg vs.283.7 ± 102.4 μg, respectively; P = 0.004) compared to non-ESPB group. The ESPB group consistently showed lower accumulated analgesic consumption compared with those in the non-ESPB group at all observed time-points (all P < 0.05) after 2 hours and the degree of the accumulated analgesic consumption reduction was greater (P = 0.04) during the 24-hour postoperative period. Pain severity was lower in the ESPB group at 6-hours postoperatively. The significantly reduced opioid consumption in ESPB group may imply that while preliminary and in need of confirmation, ESPB has potential visceral analgesic effect. Therefore, performing ESPB solely may be feasible in inducing both somatic and visceral analgesia.
竖脊肌平面阻滞（ESPB）的内脏镇痛效果仍存在争议。本研究旨在探讨临床环境中 ESPB 的内脏镇痛效果。将接受腹腔镜胆囊切除术（LC）的所有患者随机分为两组，两组均行超声引导下双侧腹直肌鞘阻滞（RSB）以预防术后躯体疼痛，干预组则加行超声引导下 T7 水平双侧 ESPB 以提供内脏镇痛阻滞。ESPB 组术中瑞芬太尼的需求（P=0.021）和术后 24 小时累积芬太尼消耗量显著低于非 ESPB 组（分别为 206.5±82.8μg 与 283.7±102.4μg；P=0.004）。与非 ESPB 组相比，ESPB 组在术后 2 小时后所有观察时间点的累积镇痛药物消耗均较低（所有 P<0.05），且在术后 24 小时内的累积镇痛药物消耗减少程度更大（P=0.04）。术后 6 小时时，ESPB 组的疼痛严重程度较低。ESPB 组阿片类药物消耗减少可能意味着虽然初步且需要进一步证实，但 ESPB 具有潜在的内脏镇痛作用。因此，单独行 ESPB 可能可行以同时诱导躯体和内脏镇痛。
