Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India.
Department of Anaesthesia and Critical Care Medicine, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India.
Interact Cardiovasc Thorac Surg. 2021 May 27;32(6):873-877. doi: 10.1093/icvts/ivab010.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether erector spinae plane block (ESPB) resulted in improved postoperative analgesia and enhanced recovery in adult cardiac surgical patients. A total of 333 papers were found using the reported search of which, 7 papers represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient groups studied, study type, relevant outcomes and results of these papers are tabulated. The cardiac surgical procedures included off-pump coronary artery bypass surgery (1 study), mitral/tricuspid valve repair (1 study), robotic minimally invasive coronary artery bypass surgery (1 study) and other cardiac surgeries (4 studies). ESPB was compared to intravenous analgesia (5 studies), thoracic epidural analgesia (1 study) and serratus anterior plane block and paravertebral block (1 study). With ESPB, there was significant improvement in postoperative pain scores (4 studies), decreased opioid requirement/rescue analgesia (3 studies), increased duration of analgesia (1 study), decreased time to extubation (3 studies), less increase in postoperative Troponin T (1 study), earlier ambulation (2 studies), earlier oral intake (1 study), earlier chest drain removal (1 study), better patient satisfaction (1 study), reduced adverse events (1 study) and decreased intensive care unit stay (3 studies). We conclude that ESPB may be associated with improved postoperative analgesia and enhanced recovery after adult cardiac surgery based on the available evidence. However, there is a need for better quality randomized controlled trials to consolidate these findings.
采用结构化方案编写了一篇心脏外科学最佳证据主题。所提出的问题是，竖脊肌平面阻滞（ESP 阻滞）是否能改善成年心脏手术患者的术后镇痛效果和促进康复。通过报道的检索共发现 333 篇论文，其中 7 篇论文为回答临床问题提供了最佳证据。作者、期刊、发表日期和国家、研究的患者群体、研究类型、这些论文的相关结局和结果均列于表中。心脏外科手术包括非体外循环冠状动脉旁路移植术（1 项研究）、二尖瓣/三尖瓣修复术（1 项研究）、机器人微创冠状动脉旁路移植术（1 项研究）和其他心脏手术（4 项研究）。ESP 阻滞与静脉内镇痛（5 项研究）、胸段硬膜外镇痛（1 项研究）、前锯肌平面阻滞和椎旁阻滞（1 项研究）进行了比较。采用 ESPB，术后疼痛评分显著改善（4 项研究）、阿片类药物需求/解救镇痛减少（3 项研究）、镇痛持续时间延长（1 项研究）、拔管时间缩短（3 项研究）、术后肌钙蛋白 T 升高减少（1 项研究）、更早下地活动（2 项研究）、更早口服摄入（1 项研究）、更早拔除胸腔引流管（1 项研究）、患者满意度提高（1 项研究）、不良事件减少（1 项研究）、重症监护病房停留时间缩短（3 项研究）。我们的结论是，根据现有证据，ESP 阻滞可能与成年心脏手术后改善术后镇痛和促进康复有关。然而，需要更好质量的随机对照试验来证实这些发现。
