超声引导竖脊肌平面阻滞与斜肋下经腹横肌平面阻滞用于老年患者腹腔镜结直肠手术后镇痛的比较：一项前瞻性随机研究
Comparison of Ultrasound-Guided Erector Spinae Plane Block and Oblique Subcostal Transverse Abdominis Plane Block for Postoperative Analgesia in Elderly Patients After Laparoscopic Colorectal Surgery: A Prospective Randomized Study.
作者信息
Qi-Hong Shen, Xu-Yan Zhou, Xu Shen, Yan-Jun Chen, Ke Liu, Rong Wang
机构信息
Department of Anesthesiology, The First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, No. 1882, Zhonghuan South Road, Jiaxing, 314001, Zhejiang, China.
出版信息
Pain Ther. 2021 Dec;10(2):1709-1718. doi: 10.1007/s40122-021-00329-x. Epub 2021 Oct 15.
INTRODUCTION
Postoperative analgesia in elderly patients is still a thorny problem. Ultrasound-guided oblique subcostal transverse abdominis plane block (TAPB) has been demonstrated to provide postoperative analgesia after abdominal surgeries. However, recent studies have suggested that an alternative method, erector spinae plane block (ESPB), might also be effective. In this study, we compared the postoperative analgesic effects of ESPB and TAPB in elderly patients who had undergone laparoscopic colorectal surgery.
METHODS
Sixty-two elderly patients (≥ 65 years old) scheduled for elective laparoscopic colorectal surgery with general anesthesia were randomly allocated to two equally sized groups: ESPB group and TAPB group. The ESPB group had a bilateral erector spinae plane block, and the TAPB group had a bilateral oblique subcostal transverse abdominis plane block. The primary outcome was visual analogue scale (VAS) pain score during the first 24 postoperative hours at resting and active states. The secondary outcomes were postoperative consumption of sufentanil, satisfaction score, the number of patients who required antiemetics, incidence of block-related complications, and other side events.
RESULTS
There were no demographic differences between two groups. Compared to the TAPB group, the ESPB group had lower VAS pain scores and sufentanil consumption during the first 24 postoperative hours. Additionally, ESPB reduced the occurrence of postoperative nausea and vomiting. Furthermore, the satisfaction score was higher in the ESPB group. No other complications were reported between the two groups.
CONCLUSIONS
Compared with oblique subcostal TAPB, ESPB more effectively reduced postoperative pain and opioid consumption. Thus, ESPB is suitable for postoperative analgesia in elderly patients who have undergone laparoscopic colorectal surgery.
TRIAL REGISTRATION
Chinese Clinical Trial Registry: ChiCTR2000033236.
引言
老年患者的术后镇痛仍然是一个棘手的问题。超声引导下斜肋下腹横肌平面阻滞（TAPB）已被证明可在腹部手术后提供术后镇痛。然而，最近的研究表明，一种替代方法，竖脊肌平面阻滞（ESPB），可能也有效。在本研究中，我们比较了ESPB和TAPB对接受腹腔镜结直肠手术的老年患者的术后镇痛效果。
方法
62例计划接受全身麻醉下择期腹腔镜结直肠手术的老年患者（≥65岁）被随机分为两组，每组人数相等：ESPB组和TAPB组。ESPB组接受双侧竖脊肌平面阻滞，TAPB组接受双侧斜肋下腹横肌平面阻滞。主要结局是术后24小时内静息和活动状态下的视觉模拟评分（VAS）疼痛评分。次要结局包括术后舒芬太尼消耗量、满意度评分、需要使用止吐药的患者数量、阻滞相关并发症的发生率以及其他不良事件。
结果
两组在人口统计学上无差异。与TAPB组相比，ESPB组在术后24小时内的VAS疼痛评分和舒芬太尼消耗量更低。此外，ESPB减少了术后恶心和呕吐的发生。此外，ESPB组的满意度评分更高。两组之间未报告其他并发症。
结论
与斜肋下TAPB相比，ESPB更有效地减轻了术后疼痛和阿片类药物的消耗量。因此，ESPB适用于接受腹腔镜结直肠手术的老年患者的术后镇痛。
试验注册
中国临床试验注册中心：ChiCTR2000033236。
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