Swati Srivastava, Shagufta Naaz, Erum Ozair, Adil Asghar, Urvashi Yadav
Department of Cardiac Anaesthesia, LPS Institute of Cardiology, GSVM Medical College, Kanpur, Uttar Pradesh, India.
Department of Anaesthesiology, AIIMS, Patna, Bihar, India.
Anesth Essays Res. 2020 Jul-Sep;14(3):376-383. doi: 10.4103/aer.AER_100_20. Epub 2021 Mar 22.
Effective postoperative analgesia leads to early mobilization, fewer pulmonary complications, and shorter hospital stay.
We compared the analgesic effects of ultrasound-guided intercostal nerve (ICN) blocks, subcostal transversus abdominis plane (SCTAP) block, and a control group in open cholecystectomy.
This was a prospective, randomized controlled, double-blind, multi-arm and parallel study.
The study was conducted on patients of American Society of Anaesthesiology Physical Status Classes I and II, either sex, 18-60 years of age, and body mass index 18-30 kg.m. Exclusion criteria were infection at the injection site, coagulopathy, thrombocytopenia, and allergy to the drugs used. Group I ( = 41) received ICN blocks, Group T ( = 41) SCTAP block, and Group C ( = 41) no postoperative block. The duration of analgesia was the primary outcome, and the analgesic consumption, the pain intensity, adverse events, and patient satisfaction were the secondary outcomes.
For the continuous data, analysis of variance was used for multiple group comparison and intergroup data were analyzed by Student's -test. Kruskal-Wallis and Mann-Whitney U tests were applied for ordinal data. = 0.05 or less was considered statistically significant.
The duration of postoperative analgesia was significantly longer in the ICN (mean = 441.6 min; 95% confidence interval [CI], 407.71, 475.49) and SCTAP block (mean = 417.6 min; 95% CI, 390.94, 444.26) as compared to control (mean = 33.98 min; 95% CI, 26.64, 41.32) ( = 0.00) with no significant intergroup difference between the two intervention groups ( = 0.278). The cumulative analgesic consumption was not significantly different between the intervention groups but was significantly reduced in the study groups when compared with the control group ( < 0.001). No notable adverse events were observed. Patients with both the techniques were very satisfied in comparison with the control group ( = 0.00).
Both the ICN and SCTAP blocks have similar results in terms of analgesia and patient satisfaction for cholecystectomy.
有效的术后镇痛可促进早期活动、减少肺部并发症并缩短住院时间。
我们比较了超声引导下肋间神经（ICN）阻滞、肋下腹横肌平面（SCTAP）阻滞与对照组在开腹胆囊切除术中的镇痛效果。
这是一项前瞻性、随机对照、双盲、多组平行研究。
研究对象为美国麻醉医师协会身体状况分级为I级和II级、年龄18 - 60岁、体重指数18 - 30 kg·m²的患者，性别不限。排除标准为注射部位感染、凝血功能障碍、血小板减少以及对所用药物过敏。I组（n = 41）接受ICN阻滞，T组（n = 41）接受SCTAP阻滞，C组（n = 41）术后不进行阻滞。镇痛持续时间为主要观察指标，镇痛药物消耗量、疼痛强度、不良事件及患者满意度为次要观察指标。
对于连续数据，采用方差分析进行多组比较，组间数据采用Student's t检验分析。对于有序数据，应用Kruskal - Wallis和Mann - Whitney U检验。P = 0.05或更低被认为具有统计学意义。
与对照组（平均 = 33.98分钟；95%置信区间[CI]，26.64，41.32）相比，ICN组（平均 = 441.6分钟；95% CI，407.71，475.49）和SCTAP阻滞组（平均 = 417.6分钟；95% CI，390.94，444.26）的术后镇痛持续时间显著更长（P = 0.00），两个干预组之间无显著组间差异（P = 0.278）。干预组之间累积镇痛药物消耗量无显著差异，但与对照组相比，研究组显著降低（P < 0.001）。未观察到明显不良事件。与对照组相比，两种技术的患者均非常满意（P = 0.00）。
在胆囊切除术的镇痛效果和患者满意度方面，ICN阻滞和SCTAP阻滞的结果相似。
