Division of Anaesthesiology, Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland; EU COST Action 15204 Euro-Periscope, Brussels, Belgium.
Division of Anaesthesiology, Mater Misericordiae University Hospital, Dublin, Ireland.
Br J Anaesth. 2020 Nov;125(5):802-810. doi: 10.1016/j.bja.2020.06.020. Epub 2020 Jul 11.
Minimally invasive thoracic surgery causes significant postoperative pain. Erector spinae plane (ESP) block and serratus anterior plane (SAP) block promise effective thoracic analgesia compared with systemically administered opioids, but have never been compared in terms of terms of quality of recovery and overall morbidity after minimally invasive thoracic surgery.
Sixty adult patients undergoing minimally invasive thoracic surgery were randomly assigned to receive either single-shot ESP or SAP block before surgery using levobupivacaine 0.25%, 30 ml. The primary outcome was quality of patient recovery at 24 h, using the Quality of Recovery-15 (QoR-15) scale. Secondary outcomes included area under the curve (AUC) of pain verbal rating scale (VRS) over time, time to first opioid analgesia, postoperative 24 h opioid consumption, in-hospital comprehensive complication index (CCI) score and hospital stay.
The QoR-15 score was higher among ESP patients compared with those in the SAP group, mean (standard deviation): 114 (16) vs 102 (22) (P=0.02). Time (min) to first i.v. opioid analgesia in recovery was 32.6 (20.6) in ESP vs 12.7 (9.5) in SAP (P=0.003). AUC at rest was 92 (31) mm hvs 112 (35) in ESP and SAP (P=0.03), respectively, whereas AUC on deep inspiration was 107 mm h (32) vs 129 (32) in ESP and SAP (P=0.01), respectively. VRS pain on movement in ESP and SAP at 24 h was, median (25-75% range): 4 (2-4) vs 5 (3-6) (P=0.04), respectively. Opioid consumption at 24 h postoperatively was 29 (31) vs 39 (34) (P=0.37). Median (25-75%) CCI in ESP and SAP was 1 (0-2) vs 4 (0-26) (P=0.03), whereas hospital stay was 3 (2-6) vs 6 (3-9) days (P=0.17), respectively.
Compared with SAP, ESP provides superior quality of recovery at 24 h, lower morbidity, and better analgesia after minimally invasive thoracic surgery.
NCT03862612.
微创胸科手术后会产生明显的术后疼痛。竖脊肌平面（ESP）阻滞和前锯肌平面（SAP）阻滞在提供胸科镇痛方面优于全身阿片类药物，但在微创胸科手术后的恢复质量和总体发病率方面从未进行过比较。
60 名接受微创胸科手术的成年患者被随机分配在手术前接受单次 ESP 或 SAP 阻滞，使用左旋布比卡因 0.25%，30ml。主要结局是使用恢复质量-15（QoR-15）量表在 24 小时时评估患者的恢复质量。次要结局包括疼痛视觉评分量表（VRS）的曲线下面积（AUC）随时间的变化、首次使用阿片类药物的时间、术后 24 小时阿片类药物的消耗量、住院综合并发症指数（CCI）评分和住院时间。
与 SAP 组相比，ESP 组的 QoR-15 评分更高，平均值（标准差）：114（16）比 102（22）（P=0.02）。ESP 组患者首次静脉注射阿片类药物的时间（分钟）为 32.6（20.6），而 SAP 组为 12.7（9.5）（P=0.003）。ESP 和 SAP 在静息时的 AUC 分别为 92（31）mm h 和 112（35）mm h（P=0.03），而在深吸气时的 AUC 分别为 107mm h（32）和 129mm h（32）（P=0.01）。ESP 和 SAP 组在 24 小时时的运动 VRS 疼痛中位数（25-75%范围）：4（2-4）比 5（3-6）（P=0.04）。术后 24 小时阿片类药物消耗量为 29（31）比 39（34）（P=0.37）。ESP 和 SAP 的中位（25-75%）CCI 分别为 1（0-2）和 4（0-26）（P=0.03），住院时间分别为 3（2-6）和 6（3-9）天（P=0.17）。
与 SAP 相比，ESP 在微创胸科手术后 24 小时时提供了更好的恢复质量、更低的发病率和更好的镇痛效果。
NCT03862612。
