Department of Anesthesiology and Reanimation, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey.
Department of Thoracic Surgery, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey.
Gen Thorac Cardiovasc Surg. 2022 Jan;70(1):64-71. doi: 10.1007/s11748-021-01687-1. Epub 2021 Aug 4.
The aim of this prospective, randomized, controlled study was to evaluate the analgesic effect of ultrasonography (USG) guided continuous erector spinae plane block (ESPB) for postoperative analgesia in video-assisted thoracoscopic surgery (VATS).
Eighty American Society of Anesthesiologists (ASA) physical status I-III patients aged 18-75 and who were to undergo VATS were included in this study. Randomization was performed in 2 groups, continuous ESPB (ESPB Group) and no intervention (Control Group). 20 mL of 0.25% bupivacaine was administered for the block. Immediately after surgery, the patient received continuous infusion of 0.125% bupivacaine at 4 mL h via the catheter inserted for the block. Patients in both groups received tramadol via an intravenous patient-controlled analgesia device. Tramadol and meperidine consumption, visual analog scale pain scores and opioid-related side effects were recorded at 0, 1, 4, 8, 12, 24, 36, and 48 h postoperatively.
The use of continuous ESPB in VATS significantly decreased the amount of tramadol used in the first 48 h postoperatively (P < 0.001). There was a statistically significant difference in the number of meperidine rescue analgesia administered between the ESPB and Control Groups (P < 0.001). While the incidences of nausea and itching were higher in Control Group, there were no differences in terms of the other side effects between the groups.
This study shows that USG-guided continuous ESPB provides adequate analgesia following VATS as part of multimodal analgesia. Continuous ESPB significantly reduced opioid consumption and opioid-related side effects compared to those in the Control Group.
本前瞻性、随机、对照研究旨在评估超声引导下连续竖脊肌平面阻滞（ESPB）在电视辅助胸腔镜手术（VATS）术后镇痛中的效果。
本研究纳入了 80 例美国麻醉医师协会（ASA）分级 I-III 级、18-75 岁、拟行 VATS 的患者。将患者随机分为连续 ESPB（ESPB 组）和无干预（对照组）两组。阻滞时给予 20mL0.25%布比卡因。术后立即通过置入的导管以 4mL/h 的速度持续输注 0.125%布比卡因。两组患者均通过静脉患者自控镇痛装置给予曲马多。记录术后 0、1、4、8、12、24、36 和 48h 时曲马多和哌替啶的消耗量、视觉模拟评分（VAS）疼痛评分和阿片类药物相关不良反应。
VATS 中连续 ESPB 的应用显著减少了术后前 48h 曲马多的用量（P < 0.001）。ESPB 组和对照组之间需要哌替啶解救镇痛的次数存在统计学差异（P < 0.001）。虽然对照组恶心和瘙痒的发生率较高，但两组之间其他不良反应的发生率无差异。
本研究表明，超声引导下连续 ESPB 作为多模式镇痛的一部分，可为 VATS 后提供充分的镇痛。与对照组相比，连续 ESPB 显著减少了阿片类药物的消耗和阿片类药物相关的不良反应。
