经胸骨切开术的冠状动脉旁路手术中经胸骨旁阻滞减少术中阿片类药物使用的效果：一项随机对照试验。

Efficacy of parasternal block to decrease intraoperative opioid use in coronary artery bypass surgery via sternotomy: a randomized controlled trial.

机构信息

Anesthesiology Department, CMC Ambroise Paré, Neuilly-sur-Seine, France

Clinical Research Department, CMC Ambroise Paré, Neuilly-sur-Seine, France.

出版信息

Reg Anesth Pain Med. 2021 Aug;46(8):671-678. doi: 10.1136/rapm-2020-102207. Epub 2021 May 14.

DOI:10.1136/rapm-2020-102207

PMID:33990437

Abstract

OBJECTIVE

This study aims to assess the effect of a preoperative parasternal plane block (PSB) on opioid consumption required to maintain hemodynamic stability during sternotomy for coronary artery bypass graft surgery.

METHODS

This double-blind, randomized, placebo-controlled trial prospectively enrolled 35 patients scheduled for coronary artery bypass graft surgery under general anesthesia with propofol and remifentanil. Patients were randomized to receive preoperative PSB using either ropivacaine (PSB group) or saline solution (placebo group) (1:1 ratio). The primary endpoint was the maximal effect-site concentration of remifentanil required to maintain heart rate and blood pressure within the recommended ranges during sternotomy.

RESULTS

Median maximum concentration of remifentanil necessary to maintain adequate hemodynamic status during sternotomy was significantly reduced in PSB group (4.2 (2.5-6.0) ng/mL) compared with placebo group (7.0 (5.2-8.0) ng/mL) (p=0.02). Mean maximum concentration of propofol used to control depth of anesthesia was also reduced (3.9±1.1 µg/mL vs 5.0±1.5 µg/mL, PSB vs placebo, respectively; p=0.02). This reduction in propofol consumption during sternotomy enabled a more adequate level of sedation to be maintained in patients (minimum patient state index was 11.7±8.7 in placebo group and 18.3±6.8 in PSB group; p=0.02). PSB reduced postoperative inflammatory response by limiting concentrations of proinflammatory cytokines IL-8, IL-18, IL-23, IL-33 and MCP-1 measured in the first 7-day after surgery (p<0.05).

CONCLUSIONS

Preoperative PSB reduced the maximum concentrations of remifentanil and propofol required to maintain hemodynamic stability and depth of anesthesia during sternotomy.

TRIAL REGISTRATION NUMBER

NCT03734159.Sébastien Bloc, M.D.; Brieuc P. Pérot, Ph.D.; Hadrien Gibert, M.D.; Jean-Dominique Law Koune, M.D.; Yannick Burg, M.D.; Didier Leclerc, M.D.; Anne-Sophie Vuitton, M.D.; Christophe De La Jonquière, M.D.; Marine Luka, L.S.; Thierry Waldmann, M.D.; Nicolas Vistarini, M.D.; Stéphane Aubert, M.D.; Mickaël M. Ménager, Ph.D.; Messaouda Merzoug, Ph.D.; Cécile Naudin, Ph.D.; Pierre Squara, M.D..

摘要

目的

本研究旨在评估术前胸骨旁平面阻滞（PSB）对行冠状动脉旁路移植术患者胸骨切开术中维持血流动力学稳定所需阿片类药物用量的影响。

方法

这是一项前瞻性、双盲、随机、安慰剂对照试验，纳入 35 例在异丙酚和瑞芬太尼全身麻醉下拟行冠状动脉旁路移植术的患者。患者随机接受术前 PSB 治疗，使用罗哌卡因（PSB 组）或生理盐水（安慰剂组）（1:1 比例）。主要终点是 PSB 组在胸骨切开术中维持心率和血压在推荐范围内所需的瑞芬太尼最大效应部位浓度。

结果

PSB 组在胸骨切开术中维持足够血流动力学状态所需的瑞芬太尼最大浓度中位数明显低于安慰剂组（4.2（2.5-6.0）ng/ml 比 7.0（5.2-8.0）ng/ml；p=0.02）。用于控制麻醉深度的丙泊酚最大浓度也有所降低（PSB 组 3.9±1.1 μg/ml 比安慰剂组 5.0±1.5 μg/ml；p=0.02）。PSB 组在胸骨切开术中丙泊酚的消耗减少使患者维持更适当的镇静水平（安慰剂组最低患者状态指数为 11.7±8.7，PSB 组为 18.3±6.8；p=0.02）。PSB 通过限制手术后第 1 至 7 天内测量的促炎细胞因子 IL-8、IL-18、IL-23、IL-33 和 MCP-1 的浓度来减少术后炎症反应（p<0.05）。

结论

术前 PSB 降低了维持胸骨切开术中血流动力学稳定和麻醉深度所需的瑞芬太尼和丙泊酚的最大浓度。

试验注册号

NCT03734159.

Sébastien Bloc，医学博士；Brieuc P. Pérot，博士；Hadrien Gibert，医学博士；Jean-Dominique Law Koune，医学博士；Yannick Burg，医学博士；Didier Leclerc，医学博士；Anne-Sophie Vuitton，医学博士；Christophe De La Jonquière，医学博士；Marine Luka，理学学士；Thierry Waldmann，医学博士；Nicolas Vistarini，医学博士；Stéphane Aubert，医学博士；Mickaël M. Ménager，博士；Messaouda Merzoug，博士；Cécile Naudin，博士；Pierre Squara，医学博士。