Department of Anesthesiology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
Department of Cardiology, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
J Cardiothorac Vasc Anesth. 2021 Jul;35(7):2088-2093. doi: 10.1053/j.jvca.2020.11.049. Epub 2020 Nov 26.
Pediatric patients undergoing subcutaneous implantable cardioverter-defibrillator (S-ICD) placement usually have substantial postoperative pain. The aim of this study was to investigate the effect of the transversus thoracic muscle plane (TTMP) block combined with serratus anterior plane block (SAPB) in patients undergoing S-ICD placement.
A double-blind, randomized controlled study.
First Affiliated Hospital of Nanchang University.
Patients aged nine-to-18 years undergoing S-ICD placement were included.
A group of 102 patients randomly were allocated to either receive combined nerve blocks (NER group) or no nerve block (CON group).
The primary endpoint was perioperative fentanyl consumption. The secondary outcome measures included pain at rest and after movement at two, four, six, 12, 24, and 48 hours after extubation; 48-hour acetaminophen administration; time to extubation; length of stay in the postanesthesia care unit (PACU); length of hospital stay; codeine tablet consumption; and percentage of patients who had codeine tablets after discharge. The NER group reported significantly less intraoperative (4.1 μg/kg v 3.1 μg/kg, p = 0.04) and postoperative fentanyl consumption (3.8 μg/kg v 1.5 μg/kg, p = 0.006) than the CON group. Compared with the NER group, the CON group had higher Numerical Rating Scale (NRS) pain scores at 24 hours after surgery both at rest and after movement. The time to extubation (20.5 minutes v 12.6 minutes, p = 0.03) and length of stay in the PACU (30.5 minutes v 15.6 minutes, p = 0.02) were significantly decreased in the NER group compared with the CON group. The CON group had a significantly higher postoperative acetaminophen requirement than did the NER group (32 mg/kg v 16 mg/kg, p = 0.01).
TTMP block combined with SAPB in pediatric S-ICD placement could provide effective analgesia.
接受皮下植入式心律转复除颤器（S-ICD）植入术的儿科患者通常会有明显的术后疼痛。本研究旨在探讨胸横肌平面（TTMP）阻滞联合前锯肌平面阻滞（SAPB）在 S-ICD 植入术中的效果。
双盲、随机对照研究。
南昌大学第一附属医院。
纳入年龄在 9 至 18 岁之间接受 S-ICD 植入术的患者。
将 102 例患者随机分为接受联合神经阻滞组（NER 组）或不接受神经阻滞组（CON 组）。
主要终点是围手术期芬太尼的使用量。次要观察指标包括拔管后 2、4、6、12、24 和 48 小时的静息和运动后疼痛；48 小时内对乙酰氨基酚的使用；拔管时间；麻醉后监护病房（PACU）停留时间；住院时间；可待因片的使用量；以及出院后有可待因片的患者比例。与 CON 组相比，NER 组术中（4.1μg/kg 比 3.1μg/kg，p=0.04）和术后芬太尼的使用量（3.8μg/kg 比 1.5μg/kg，p=0.006）明显更少。与 NER 组相比，CON 组术后 24 小时静息和运动时的数字评分量表（NRS）疼痛评分更高。与 CON 组相比，NER 组的拔管时间（20.5 分钟比 12.6 分钟，p=0.03）和 PACU 停留时间（30.5 分钟比 15.6 分钟，p=0.02）明显缩短。与 NER 组相比，CON 组术后对乙酰氨基酚的需求量明显更高（32mg/kg 比 16mg/kg，p=0.01）。
在儿科 S-ICD 植入术中，TTMP 阻滞联合 SAPB 可提供有效的镇痛效果。
