超声引导双侧单次注射竖脊肌平面阻滞与切口浸润用于腹腔镜辅助结直肠手术后镇痛的比较：一项前瞻性随机研究。

A comparison of ultrasound guided bilateral single injection shot Erector Spinae Plane blocks versus wound infiltration for post-operative analgesia in laparoscopic assisted colonic surgery- a prospective randomised study.

机构信息

Acute Care Medicine, The University of Adelaide, The Queen Elizabeth Hospital, Adelaide, SA, Australia.

Department of Anaesthesia, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA, 5011, Australia.

出版信息

BMC Anesthesiol. 2021 Oct 26;21(1):255. doi: 10.1186/s12871-021-01474-8.

DOI:10.1186/s12871-021-01474-8

PMID:34702183

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8547045/

Abstract

BACKGROUND

Both wound infiltration (WI) with local anaesthetic and Erector Spinae Plane block (ESPB) have been described for post-operative analgesia after abdominal surgery. This study compared the efficacy of WI versus ESPB for post-operative analgesia after laparoscopic assisted colonic surgery.

METHODS

Seventy-two patients between 18 and 85 years of age undergoing elective surgery were randomised to receive either WI or ESPB. In the WI group a 40 ml bolus of 0.5% Ropivacaine, infiltrated at the ports and minimally invasive wound at subcutaneous and fascia layers. In the ESPB group at T8 level, under ultrasound guidance, a 22-gauge nerve block needle was passed through the Erector Spinae muscle to reach its fascia. A dose up to 40 ml of 0.5% Ropivacaine, divided into two equal volumes, was injected at each side. Both groups had a multimodal analgesic regime, including regular Paracetamol, dexamethasone and patient-controlled analgesia (PCA) with Fentanyl. The primary end point was a post-operative pain score utilising a verbal Numerical Rating Score (NRS, 0-10) on rest and coughing in the post anaesthetic care unit (PACU) and in the first 24 h. Secondary outcomes measured were: opioid usage, length of stay and any clinical adverse events.

RESULTS

There was no significant treatment difference in PACU NRS at rest and coughing (p-values 0. 382 and 0.595respectively). Similarly, there were no significant differences in first 24 h NRS at rest and coughing (p-values 0.285 and 0.431 respectively). There was no significant difference in Fentanyl use in PACU or in the first 24 h (p- values 0.900 and 0.783 respectively). Neither was there a significant difference found in mean total Fentanyl use between ESPB and WI groups (p-value 0.787).

CONCLUSION

Our observations found both interventions had an overall similar efficacy.

TRIAL REGISTRATION

The study was registered with the Australian New Zealand Clinical Trial Registry (ACTRN: 12619000113156 ).

摘要

背景

局部浸润麻醉（WI）和竖脊肌平面阻滞（ESPB）均已被用于腹部手术后的术后镇痛。本研究比较了 WI 与 ESPB 在腹腔镜辅助结肠手术后的术后镇痛效果。

方法

72 名年龄在 18 至 85 岁之间的择期手术患者被随机分为 WI 组或 ESPB 组。在 WI 组中，在切口和微创伤口的皮下和筋膜层注入 40ml 0.5%罗哌卡因。在 ESPB 组中，在 T8 水平，在超声引导下，将 22 号神经阻滞针穿过竖脊肌到达筋膜。在每侧注入 40ml 0.5%罗哌卡因，分为两等份。两组均采用多模式镇痛方案，包括常规使用对乙酰氨基酚、地塞米松和芬太尼患者自控镇痛（PCA）。主要终点是术后疼痛评分，采用术后麻醉恢复室（PACU）和 24 小时内的静息和咳嗽时的数字评分量表（NRS，0-10）。次要结局测量包括：阿片类药物使用量、住院时间和任何临床不良事件。

结果

PACU 休息和咳嗽时的 NRS 无显著治疗差异（p 值分别为 0.382 和 0.595）。同样，24 小时内休息和咳嗽时的 NRS 也无显著差异（p 值分别为 0.285 和 0.431）。PACU 或 24 小时内芬太尼的使用无显著差异（p 值分别为 0.900 和 0.783）。ESPB 和 WI 组之间的芬太尼总用量也无显著差异（p 值为 0.787）。