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术后胸壁痛治疗:前锯肌平面阻滞还是竖脊肌平面阻滞?

Postoperative Thoracic Pain Treatment: Serratus Anterior or Erector Spinae Plane Block?

机构信息

Department of Anesthesiology and Reanimation, Erciyes University Medical Faculty, Kayseri, Turkey.

Department of Thoracic Surgery, Erciyes University Medical Faculty, Kayseri, Turkey.

出版信息

Thorac Cardiovasc Surg. 2021 Sep;69(6):570-576. doi: 10.1055/s-0040-1715491. Epub 2020 Oct 25.

Abstract

BACKGROUND

Thoracic surgery is one of the most painful surgeries. Effective analgesia is important in postoperative pain management. In this study, we aimed to compare the two new fascial block techniques.

METHODS

A total of 107 patients who underwent thoracic surgery between October 2018 and November 2019 were retrospectively evaluated. The study included 59 patients in the serratus anterior plane block (SAPB) group and 48 patients in the erector spinae plane block (ESPB) group. Both groups were administered 30 mL of 0.25% bupivacaine and their morphine consumption was evaluated by a patient-controlled analgesia (PCA) method during the 2nd, 6th, 12th, 24th, and 48th postoperative hours. Pain was measured with the visual analog scale (VAS). Intraoperative mean arterial pressure (MAP) and heart rate (HR) were recorded.

RESULTS

During the first 24 hours, VAS values were significantly lower in the ESPB group ( < 0.05). Moreover, morphine consumption was significantly lower in the ESPB group in the 24th and 48th hours ( < 0.05). Intraoperative remifentanil consumption was also significantly lower in the ESPB group ( < 0.05). Intraoperative MAP in the ESPB group was found to be significantly lower after the 4th hour. HR was similar in both groups.

CONCLUSION

ESPB was more effective compared with SAPB in postoperative thoracic pain management.

摘要

背景

胸外科手术是最疼痛的手术之一。有效的镇痛在术后疼痛管理中很重要。在本研究中,我们旨在比较两种新的筋膜阻滞技术。

方法

回顾性评估了 2018 年 10 月至 2019 年 11 月期间接受胸外科手术的 107 名患者。研究包括 59 例胸肌前平面阻滞(SAPB)组和 48 例竖脊肌平面阻滞(ESPB)组。两组均给予 30ml0.25%布比卡因,并采用患者自控镇痛(PCA)方法评估术后第 2、6、12、24 和 48 小时的吗啡消耗量。疼痛采用视觉模拟评分(VAS)进行评估。记录术中平均动脉压(MAP)和心率(HR)。

结果

在最初的 24 小时内,ESPB 组的 VAS 值明显较低(<0.05)。此外,ESPB 组在第 24 和 48 小时的吗啡消耗量明显较低(<0.05)。ESPB 组术中瑞芬太尼的消耗量也明显较低(<0.05)。ESPB 组在第 4 小时后术中 MAP 明显较低。两组的 HR 相似。

结论

与 SAPB 相比,ESPB 在术后胸疼管理中更有效。

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