Elmunzer B Joseph, Lewis Briana R, Miller Kristen F, Wolf Bethany J, Zeiler Lydia, Gutman David A, Elias Pooja, Tansel Aylin, Moran Robert A, Bolin Eric D
Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC, USA.
Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
Tech Innov Gastrointest Endosc. 2021;23(4):297-303. doi: 10.1016/j.tige.2021.06.006. Epub 2021 Jun 24.
Excess post-operative opioid medication use can delay recovery and is associated with long-term misuse, addiction, and overdose. We aimed to explore the effect of pre-procedural thoracic paravertebral nerve block (PNB) on pain-related outcomes after POEM.
In this retrospective cohort study, consecutive patients who did and did not receive a PNB prior to POEM were compared. The outcomes were peak and cumulative pain scores, total opioid use during hospitalization, and length of stay. After adjusting for confounders, the associations between nerve block and the outcomes of interest were explored.
Forty-nine consecutive patients were enrolled; 25 patients received a block whereas the subsequent 24 did not. There were no differences in baseline characteristics between the study groups. In unadjusted analyses, there was no significant difference between patients who did and did not undergo PNB in peak pain score (7.8 vs. 8.7, p=0.14), cumulative pain score in the first 12 hours (area under curve 66.5 vs. 75.8, p=0.22), median total opioid use (38.9 mg morphine equivalent dosing vs. 42, p=1.00), and median length of hospitalization (26.5 hours vs. 24, p=0.35). In multivariable regression models, PNB was not associated with a reduction in pain scores, opioid use, or hospitalization. There were no adverse events related to the block.
In this exploratory, observational study, paravertebral nerve block immediately before POEM did not result in a statistically significant reduction in pain-related outcomes or hospitalization. Additional observational studies may elucidate whether higher anesthetic doses or longer acting formulations would be of value.
术后阿片类药物使用过量会延迟恢复，并与长期滥用、成瘾和过量用药有关。我们旨在探讨术前胸段椎旁神经阻滞（PNB）对经口内镜下肌切开术（POEM）后疼痛相关结局的影响。
在这项回顾性队列研究中，比较了在POEM之前接受和未接受PNB的连续患者。结局指标包括疼痛峰值和累积疼痛评分、住院期间的阿片类药物总用量以及住院时间。在对混杂因素进行校正后，探讨神经阻滞与感兴趣结局之间的关联。
连续纳入49例患者；25例患者接受了阻滞，随后的24例未接受。研究组之间的基线特征无差异。在未校正分析中，接受和未接受PNB的患者在疼痛峰值评分（7.8对8.7，p = 0.14）、前12小时的累积疼痛评分（曲线下面积66.5对75.8，p = 0.22）、阿片类药物总用量中位数（38.9毫克吗啡当量剂量对42，p = 1.00）以及住院时间中位数（26.5小时对24，p = 0.35）方面均无显著差异。在多变量回归模型中，PNB与疼痛评分降低、阿片类药物使用或住院时间缩短无关。没有与阻滞相关的不良事件。
在这项探索性观察研究中，POEM前立即进行的椎旁神经阻滞并未导致疼痛相关结局或住院时间有统计学意义的降低。更多的观察性研究可能会阐明更高的麻醉剂量或长效制剂是否有价值。
