使用程序化间歇性推注方案的双侧连续竖脊肌平面阻滞与鞘内注射吗啡用于活体供体腹腔镜肝切除术后镇痛的随机对照试验

Bilateral continuous erector spinae plane block using a programmed intermittent bolus regimen versus intrathecal morphine for postoperative analgesia in living donor laparoscopic hepatectomy: A randomized controlled trial.

作者信息

Kang RyungA, Chin Ki Jinn, Kim Gaab Soo, Gwak Mi Sook, Kim Jong Man, Choi Gyu-Seong, Choi Soo Joo, Lee Seung Won, Ko Justin Sangwook

机构信息

Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University of Toronto, Canada.

出版信息

J Clin Anesth. 2021 Dec;75:110479. doi: 10.1016/j.jclinane.2021.110479. Epub 2021 Aug 26.

DOI:10.1016/j.jclinane.2021.110479

PMID:34455152

Abstract

STUDY OBJECTIVE

To determine if continuous bilateral erector spinae plane (ESP) blocks would improve the postoperative analgesia in the first 48 h after laparoscopic donor hepatectomy, compared to intrathecal morphine (ITM).

DESIGN

Prospective, randomized controlled trial.

SETTING

A single tertiary care center from October 2019 and September 2020.

PATIENTS

A total of 60 donors scheduled to undergo elective laparoscopic right hepatectomy.

INTERVENTIONS

Sixty donors were randomized to receive either bilateral continuous T8 ESP blocks with a programmed intermittent bolus regimen of 10 mL 0.2% ropivacaine every 3 h for 48 h (n = 30) or 400 μg ITM (n = 30), in addition to IV fentanyl PCA and multimodal analgesia.

MEASUREMENTS

The primary outcome was cumulative opioid consumption over the first 48 h, expressed as IV morphine equivalents. Secondary outcomes included pain scores, Quality of Recovery-15 scores, ambulation within 24 h, time to first flatus, and opioid-related adverse drug events over 72 h.

MAIN RESULTS

Fifty-nine donors were analyzed. Cumulative 48-h opioid consumption was similar between the ITM and ESP groups (29.8 ± 18.2 vs. 35.1 ± 21.9 mg, mean difference (ESP-ITM) (95% CI), 5.3 (-11.5 to 22) mg; p > 0.99). Resting pain scores at 48 and 72 h postoperatively were significantly lower in the ESP group (0 [0-2] vs. 3 [1.5-3], and 0 [0-2] vs. 3 [1-3] respectively, both p<0.001) (Goldaracena and Barbas, 2019; Ko et al., 2009; Choi et al., 2007 [1-3]) respectively, both p < 0.001). The ESP group had significantly lower incidences of postoperative nausea, vomiting, and pruritus at all timepoints. There were no differences in recovery outcomes.

CONCLUSIONS

Continuous ESP blocks did not reduce cumulative 48-h opioid consumption compared to 400 μg ITM after laparoscopic donor hepatectomy, but it was associated with a significantly reduced risk of postoperative nausea, vomiting and pruritus.

CLINICAL TRIAL NUMBER AND REGISTRY URL

Clinical Trial Registry of Korea; https://cris.nih.go.kr/cris/index.jsp and identifier: KCT0004313; date of registration: October 15, 2019; principal investigator's name: Justin Sangwook Ko.

摘要

研究目的

与鞘内注射吗啡（ITM）相比，确定连续双侧竖脊肌平面（ESP）阻滞是否能改善腹腔镜供体肝切除术后48小时内的术后镇痛效果。

设计

前瞻性随机对照试验。

地点

2019年10月至2020年9月期间的一家三级医疗中心。

患者

共有60名计划接受择期腹腔镜右肝切除术的供体。

干预措施

60名供体被随机分为两组，一组接受双侧连续T8 ESP阻滞，采用每3小时10 mL 0.2%罗哌卡因的程序化间歇性推注方案，持续48小时（n = 30）；另一组接受400 μg ITM（n = 30），此外均给予静脉自控镇痛（IV PCA）芬太尼和多模式镇痛。

测量指标

主要结局是术后48小时内的累积阿片类药物消耗量，以静脉注射吗啡当量表示。次要结局包括疼痛评分、恢复质量-15评分、24小时内下床活动情况、首次排气时间以及72小时内与阿片类药物相关的不良药物事件。

主要结果

共分析了59名供体。ITM组和ESP组术后48小时的累积阿片类药物消耗量相似（29.8±18.2 vs. 35.1±21.9 mg，平均差异（ESP-ITM）（95%CI），5.3（-11.5至22）mg；p>0.99）。ESP组术后48小时和72小时的静息疼痛评分显著更低（分别为0[0-2] vs. 3[1.5-3]，以及0[0-2] vs. 3[1-3]，均p<0.001）。ESP组在所有时间点的术后恶心、呕吐和瘙痒发生率均显著更低。恢复结局方面无差异。