Department of Anaesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey.
Department of Anaesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey.
J Cardiothorac Vasc Anesth. 2022 Aug;36(8 Pt A):2313-2321. doi: 10.1053/j.jvca.2021.09.041. Epub 2021 Oct 1.
The objective of the present study was to evaluate morphine consumption and pain scores 24 hours postoperatively to compare the effects of a bilateral pectointercostal fascial block (PIFB) with those of a transversus thoracic muscle plane block (TTMPB) on acute poststernotomy pain in cardiac surgery patients who have undergone median sternotomy.
Prospective, randomized, double-blinded.
The operating room, intensive care unit, and patient ward at a university hospital.
Thirty-nine American Society of Anesthesiologists II-to-III patients aged 18- to-80 years, scheduled for elective cardiac surgery via median sternotomy.
Patients randomly were allocated to groups scheduled to receive bilateral ultrasound-guided PIFB or TTMPB.
The primary outcome was postoperative morphine use within the first 24 hours. Secondary outcomes were the numerical pain rating scale (NRS) scores at rest and during coughing, time of first analgesic demand from the patient-controlled analgesia (PCA) device, and rescue analgesia use. The nausea/vomiting scores, time to extubation, length of stays in intensive care and the hospital, patient satisfaction scores, and complications were also recorded. The first 24-hour morphine use did not significantly differ between the PIFB and TTMPB groups (mean ± standard deviation [95% CI], 13.89 ± 6.80 [10.83-16.95] mg/24 h and 15.08 ± 7.42 [11.83-18.33] mg/24 h, respectively, p = 0.608). No significant difference between the two groups in the NRS scores at rest and during coughing was observed; the groups had similar requirements for rescue analgesia in the first 24 hours (n [%], three [15.8] and seven [35], p = 0.273, respectively). The time from PCA to the first analgesia request was longer in the PIFB than in the TTMPB group (median [interquartile range], 660 [540-900] minutes, and 240 [161-525] minutes, respectively, p = 0.002).
PIFB and TTMPB showed similar effectiveness for morphine consumption within 24 hours postoperatively and in pain scores in cardiac surgery patients.
本研究旨在评估术后 24 小时吗啡消耗量和疼痛评分，比较双侧胸膜间筋膜阻滞（PIFB）与经胸横肌平面阻滞（TTMPB）对接受正中开胸心脏手术患者急性开胸后疼痛的影响。
前瞻性、随机、双盲。
大学医院的手术室、重症监护病房和病房。
39 名美国麻醉医师协会（ASA）分级 II 至 III 级、年龄 18-80 岁的患者，计划行正中开胸择期心脏手术。
患者随机分配至接受双侧超声引导下 PIFB 或 TTMPB 的组。
主要结局是术后 24 小时内吗啡的使用量。次要结局是静息和咳嗽时的数字疼痛评分量表（NRS）评分、患者从患者自控镇痛（PCA）装置首次要求镇痛的时间、以及补救性镇痛的使用。还记录了恶心/呕吐评分、拔管时间、重症监护病房和医院的住院时间、患者满意度评分和并发症。PIFB 和 TTMPB 两组间 24 小时吗啡用量无显著差异（平均±标准差[95%CI]，13.89±6.80[10.83-16.95]mg/24 h 和 15.08±7.42[11.83-18.33]mg/24 h，p=0.608）。两组在静息和咳嗽时的 NRS 评分无显著差异；两组在 24 小时内对补救性镇痛的需求相似（n[%]，三组[15.8]和七组[35]，p=0.273）。从 PCA 到首次镇痛请求的时间在 PIFB 组比 TTMPB 组长（中位数[四分位间距]，660[540-900]分钟和 240[161-525]分钟，p=0.002）。
PIFB 和 TTMPB 在术后 24 小时内吗啡消耗和心脏手术患者的疼痛评分方面效果相似。
