Abdelhamid Bassant M, Khaled Dalia, Mansour Mohamed A, Hassan Mohamed M
Department of Anesthesiology, Pain Management and Surgical Intensive Care, Faculty of Medicine, Cairo University, Cairo, Egypt -
Department of Anesthesiology, Pain Management and Surgical Intensive Care, Faculty of Medicine, Cairo University, Cairo, Egypt.
Minerva Anestesiol. 2020 Aug;86(8):816-826. doi: 10.23736/S0375-9393.20.14064-1. Epub 2020 May 22.
Pain control in the morbidly obese has presented as an anesthetic challenge. The aim of this study is to assess the analgesic efficacy of ultrasound guided bilateral erector spinae block compared to bilateral subcostal transversus abdominis plane block.
A prospective randomized, double-blinded controlled study was conducted at Kasr Alainy Hospital on 66 patients scheduled for laparoscopic sleeve gastrectomy. Patients were randomly allocated into three groups and received general anesthesia: bilateral erector spinae block at the level of T9 or bilateral subcostal transversus abdominis block or opioid analgesia (control group). The primary outcome was pain assessment by Visual Analogue Scale.
Visual Analogue Scale was lower in the erector spinae and transversus abdominis groups compared with the control group throughout the first 12 postoperative hours (P≤0.001). Visual Analogue Scale was lower in the erector spinae group in relation to control group at 18 postoperative hours (P=0.034). Visual Analogue Scale in the erector spinae group was significantly lower compared to transversus abdominis at the 12 postoperative hours. Twenty-four-hour postoperative pethidine consumption was higher in the control group (median 150, IQR 100-200) compared to both erector spinae (median 0, IQR 0-50) and transversus abdominis (median 50, IQR 0-100) groups (P<0.001). Erector spinae group showed less pethidine consumption than transversus abdominis group.
Ultrasound-guided single-shot T9 erector spinae plane block lowers postoperative pain scores, and reduces intraoperative and postoperative opioid consumption compared with both the subcostal approach transversus abdominis plane block and the control group in obese patients that had undergone sleeve gastrectomy.
病态肥胖患者的疼痛控制一直是麻醉领域的一项挑战。本研究旨在评估超声引导下双侧竖脊肌阻滞与双侧肋下腹横肌平面阻滞相比的镇痛效果。
在卡斯尔·阿莱尼医院对66例计划行腹腔镜袖状胃切除术的患者进行了一项前瞻性随机双盲对照研究。患者被随机分为三组并接受全身麻醉：T9水平双侧竖脊肌阻滞组、双侧肋下腹横肌阻滞组或阿片类镇痛（对照组）。主要结局指标是采用视觉模拟评分法进行疼痛评估。
在术后的前12小时内，竖脊肌组和腹横肌组的视觉模拟评分均低于对照组（P≤0.001）。术后18小时，竖脊肌组的视觉模拟评分低于对照组（P=0.034）。术后12小时，竖脊肌组的视觉模拟评分显著低于腹横肌组。与竖脊肌组（中位数0，四分位数间距0-50）和腹横肌组（中位数50，四分位数间距0-100）相比，对照组术后24小时哌替啶消耗量更高（中位数150，四分位数间距100-200）（P<0.001）。竖脊肌组的哌替啶消耗量低于腹横肌组。
对于接受袖状胃切除术的肥胖患者，超声引导下单次T9竖脊肌平面阻滞与肋下腹横肌平面阻滞及对照组相比，可降低术后疼痛评分，并减少术中和术后阿片类药物的消耗量。
