Department of Anesthesiology, First Affiliated Hospital of Nanchang University, Nanchang, China.
Pain Med. 2022 Mar 2;23(3):440-447. doi: 10.1093/pm/pnab291.
The optimal analgesia regimen after open cardiac surgery has been unclear. The aim of this study was to investigate the beneficial effects of continuous pecto-intercostal fascial blocks (PIFB) initiated before surgery on outcomes after open cardiac surgery.
A group of 116 patients were randomly allocated to receive either bilateral continuous PIFB (PIF group) or the same block with saline (SAL group). The primary endpoint was postoperative pain at 4, 8, 16, 24, 48, and 72 hours after extubation at rest and during exercise. The secondary outcome measures included analgesia requirements (sufentanil and flurbiprofen consumption), time to extubation, length of stay in the intensive care unit, incidence of postoperative nausea and vomiting, time until return of bowel function, time to mobilization, time to urinary catheter removal, and the length of hospital stay.
The length of stay in the intensive care unit (29 ± 7 hours vs 13 ± 4 hours, P < 0.01) and length of hospital stay (8.9 ± 0.9 days vs 6.5 ± 1.1 days, P < 0.01) were significantly longer in the SAL group than in the PIF group. Resting pain scores (2 hours after extubation: 1.1 vs 3.3, P < 0.01; 4 hours after extubation: 1.0 vs 3.5, P < 0.01; 8 hours after extubation: 1.2 vs 3.7, P < 0.01; 16 hours after extubation: 1.3 vs 3.7, P < 0.01; 24 hours after extubation: 1.4 vs 2.8, P < 0.01; 48 hours after extubation: 0.9 vs 2.2, P < 0.01; 72 hours after extubation: 0.8 vs 2.1, P < 0.01) and dynamic pain scores (2 hours after extubation: 1.4 vs 3.7, P < 0.01; 4 hours after extubation: 1.3 vs 3.8, P < 0.01; 8 hours after extubation: 1.4 vs 3.5, P < 0.01; 16 hours after extubation: 1.2 vs 3.4, P < 0.01; 24 hours after extubation: 1.1 vs 3.1, P < 0.01; 48 hours after extubation: 1.0 vs 2.9, P < 0.01; 72 hours after extubation: 0.9 vs 2.8, P < 0.01) were significantly lower in the PIF group than in the SAL group at all time points. The PIF group required significantly less intraoperative sufentanil consumption (123 ± 32 μg vs 63 ± 16 μg, P < 0.01), postoperative sufentanil consumption (102 ± 22 μg vs 52 ± 17 μg, P < 0.01), and postoperative flurbiprofen consumption (350 ± 100 mg vs 100 ± 100 mg, P < 0.01) than the SAL groups. Time to extubation (8.9 ± 2.4 hours vs 3.2 ± 1.3 hours, P < 0.01), time to first flatus (43 ± 6 hours vs 30 ± 7 hours, P < 0.01), time until mobilization (35 ± 5 hours vs 24 ± 7 hours, P < 0.01), and time until urinary catheter removal (47 ± 9 hours vs 31 ± 4 hours, P < 0.01) were significantly earlier in the PIF group than in the SAL group. The incidence of postoperative nausea and vomiting was significantly lower in the PIF group (9.1% vs 27.3%, P < 0.01).
Bilateral continuous PIFB reduced the length of hospital stay and provided effective postoperative pain relief for 3 days.
开胸手术后的最佳镇痛方案仍不明确。本研究旨在探讨手术前开始连续肋间筋膜阻滞（PIFB）对开胸手术后结局的有益影响。
将 116 名患者随机分为两组，分别接受双侧连续 PIFB（PIF 组）或相同阻滞加生理盐水（SAL 组）。主要终点是拔管后 4、8、16、24、48 和 72 小时休息和运动时的术后疼痛。次要观察指标包括镇痛需求（舒芬太尼和氟比洛芬消耗）、拔管时间、重症监护病房停留时间、术后恶心和呕吐的发生率、肠蠕动恢复时间、活动时间、导尿管拔除时间和住院时间。
SAL 组重症监护病房停留时间（29±7 小时比 13±4 小时，P<0.01）和住院时间（8.9±0.9 天比 6.5±1.1 天，P<0.01）明显长于 PIF 组。休息时疼痛评分（拔管后 2 小时：1.1 比 3.3，P<0.01；拔管后 4 小时：1.0 比 3.5，P<0.01；拔管后 8 小时：1.2 比 3.7，P<0.01；拔管后 16 小时：1.3 比 3.7，P<0.01；拔管后 24 小时：1.4 比 2.8，P<0.01；拔管后 48 小时：0.9 比 2.2，P<0.01；拔管后 72 小时：0.8 比 2.1，P<0.01）和动态疼痛评分（拔管后 2 小时：1.4 比 3.7，P<0.01；拔管后 4 小时：1.3 比 3.8，P<0.01；拔管后 8 小时：1.4 比 3.5，P<0.01；拔管后 16 小时：1.2 比 3.4，P<0.01；拔管后 24 小时：1.1 比 3.1，P<0.01；拔管后 48 小时：1.0 比 2.9，P<0.01；拔管后 72 小时：0.9 比 2.8，P<0.01）均明显低于 SAL 组。PIF 组术中舒芬太尼用量（123±32μg 比 63±16μg，P<0.01）、术后舒芬太尼用量（102±22μg 比 52±17μg，P<0.01）和术后氟比洛芬用量（350±100mg 比 100±100mg，P<0.01）明显低于 SAL 组。拔管时间（8.9±2.4 小时比 3.2±1.3 小时，P<0.01）、首次排气时间（43±6 小时比 30±7 小时，P<0.01）、活动时间（35±5 小时比 24±7 小时，P<0.01）和导尿管拔除时间（47±9 小时比 31±4 小时，P<0.01）均明显早于 SAL 组。术后恶心呕吐的发生率明显低于 PIF 组（9.1%比 27.3%，P<0.01）。
双侧连续 PIFB 可缩短住院时间，对术后 3 天的疼痛缓解效果良好。
