Aoyama Yuki, Sakura Shinichi, Tsuchiya Ritsuko, Wittayapairoj Aumjit, Saito Yoji
Department of Anesthesiology, Faculty of Medicine, Shimane University, Izumo City, Shimane, Japan.
Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
J Pain Res. 2020 Sep 23;13:2367-2376. doi: 10.2147/JPR.S265015. eCollection 2020.
Thoracic paravertebral block (TPVB) is an established analgesic technique for breast surgery although it is technically challenging. Erector spinae plane block (ESPB) requires less technical expertise and may be an alternative to TPVB. However, whether ESPB has similar analgesic effects to TPVB for breast surgery is still inconclusive. Moreover, information on sensory blockade of ESPB is scarce. Accordingly, we conducted this retrospective propensity-matched study to see if ESPB could provide comparable analgesic effects to TPVB in patients undergoing breast surgery. We also compared cutaneous sensory block levels after the two techniques.
In this retrospective cohort study, we analyzed data saved in our database and compared the two techniques using a propensity matching method. The data of patients who underwent unilateral breast surgery under general anesthesia with the addition of either TPVB or ESPB were identified. We considered that the analgesic efficacy of ESPB was noninferior to TPVB if both postoperative fentanyl consumption and area under the curve (AUC) for pain scores within 24 h were within 50 µg and 240 mm･h margins, respectively. Cutaneous sensory block levels, additional analgesic requirements, and complications were also compared between the two groups.
Among 93 patients, 30 patients for each group were matched. Both postoperative fentanyl consumption and AUC for pain scores after ESPB were noninferior to those after TPVB. ESPB did not produce sensory blockade consistently, and the number of dermatomes was smaller after ESPB [1 (0-3)] [median (interquartile range)] than after TPVB [4 (2-5)] (P=0.002). No serious complications related to blocks were observed.
ESPB and TPVB provided comparable postoperative analgesia for 24 h in patients undergoing breast surgery. Dermatomal sensory blockade was, however, less apparent and narrower after ESPB than after TPVB.
胸段椎旁阻滞（TPVB）是一种成熟的用于乳腺手术的镇痛技术，尽管其技术要求较高。竖脊肌平面阻滞（ESPB）所需的技术专长较少，可能是TPVB的替代方法。然而，ESPB在乳腺手术中是否具有与TPVB相似的镇痛效果仍尚无定论。此外，关于ESPB感觉阻滞的信息很少。因此，我们进行了这项回顾性倾向匹配研究，以观察ESPB在接受乳腺手术的患者中是否能提供与TPVB相当的镇痛效果。我们还比较了两种技术后的皮肤感觉阻滞水平。
在这项回顾性队列研究中，我们分析了数据库中保存的数据，并使用倾向匹配方法比较了这两种技术。确定了在全身麻醉下接受单侧乳腺手术并加用TPVB或ESPB的患者的数据。如果术后芬太尼消耗量和24小时内疼痛评分曲线下面积（AUC）分别在50μg和240mm·h范围内，我们认为ESPB的镇痛效果不劣于TPVB。还比较了两组之间的皮肤感觉阻滞水平、额外镇痛需求和并发症。
93例患者中，每组匹配30例。ESPB术后芬太尼消耗量和疼痛评分AUC均不劣于TPVB术后。ESPB并未持续产生感觉阻滞，且ESPB后的皮节数量[1（0-3）][中位数（四分位间距）]比TPVB后的[4（2-5）]少（P=0.002）。未观察到与阻滞相关的严重并发症。
ESPB和TPVB在接受乳腺手术的患者中提供了相当的术后24小时镇痛效果。然而，ESPB后的皮节感觉阻滞不如TPVB明显且范围更窄。
