Division of Pediatric Surgery, Children's Hospital Colorado/University of Colorado School of Medicine, 4125 Briargate Parkway, Colorado Springs, CO 80920, USA.
Division of Pediatric Anesthesia, Children's Hospital Colorado/University of Colorado School of Medicine, Colorado Springs, CO, USA.
J Pediatr Surg. 2022 Feb;57(2):207-212. doi: 10.1016/j.jpedsurg.2021.10.030. Epub 2021 Oct 30.
Postoperative pain management is a significant challenge in patients undergoing Nuss repair for pectus excavatum chest wall deformity. Therapeutic anesthetic options primarily include patient-controlled intravenous analgesia, thoracic epidural analgesia (TEA), and cryoanalgesia. However, TEA is limited to inpatient use and both TEA and cryoanalgesia can result in neurologic injury. The novel technique of ultrasound-guided erector spinae plane regional analgesia has been used recently in our patients undergoing the Nuss repair and has shown impressive pain relief, but without the potential complications of other modalities. Erector spinae plane block (ESPB) postoperative pain management outcomes were studied as compared to TEA.
Thirty consecutive patients with severe pectus excavatum undergoing Nuss repair and placement of ultrasound-guided ESPB were each paired to a historical cohort control patient with TEA postoperative pain management. The cohort patient match was defined by age (± 2 years), gender, and CT pectus index (± 15%). Study variables included hospital length of stay (LOS), pain scores, and pain medication usage.
Pain scores as measured by area under the curve per hour (Day 1: 2.72 (SD = 1.37) vs. 3.90 (SD = 1.81), P = 0.006; Day 2: 2.83 (SD = 1.32) vs. 3.97 (SD = 1.82), P = 0.007) and oral morphine equivalent (OME) pain medication usage (Day 1: 11.9 (SD = 4.9) vs 56.0 (SD = 32.2), P < 0.001; Day 2: 14.7 (SD = 7.1) vs. 38.0 (SD = 21.7), P < 0.001) were higher for the first two postoperative days in the ESPB group. However, mean hospital LOS was nearly one day shorter for ESPB patients (3.78 (SD = 0.82) vs. 2.90 (SD = 0.87), P < 0.001) who were discharged home with the catheter in place until removal, typically at 5-7 days postoperatively.
Ultrasound-guided ESPB is thus a feasible, safe, and effective alternative to TEA in postoperative pain management after Nuss repair and results in decreased hospital stay.
III.
对于接受 Nuss 修复术治疗漏斗胸胸壁畸形的患者，术后疼痛管理是一个重大挑战。治疗性麻醉选择主要包括患者自控静脉镇痛、胸椎硬膜外镇痛（TEA）和冷冻镇痛。然而，TEA 仅限于住院使用，TEA 和冷冻镇痛都可能导致神经损伤。最近，我们在接受 Nuss 修复术的患者中使用了一种新的超声引导竖脊肌平面区域镇痛技术，该技术已显示出令人印象深刻的止痛效果，但没有其他方式的潜在并发症。本研究比较了超声引导竖脊肌平面阻滞（ESPB）与 TEA 在术后疼痛管理方面的效果。
连续 30 例严重漏斗胸患者接受 Nuss 修复术和超声引导 ESPB 治疗，每位患者与一名接受 TEA 术后疼痛管理的历史队列对照患者配对。队列患者的匹配标准为年龄（±2 岁）、性别和 CT 鸡胸指数（±15%）。研究变量包括住院时间（LOS）、疼痛评分和疼痛药物使用情况。
ESPB 组患者术后第 1 天和第 2 天的疼痛评分（每小时曲线下面积，第 1 天：2.72（SD=1.37）比 3.90（SD=1.81），P=0.006；第 2 天：2.83（SD=1.32）比 3.97（SD=1.82），P=0.007）和口服吗啡等效剂量（OME）疼痛药物使用量（第 1 天：11.9（SD=4.9）比 56.0（SD=32.2），P<0.001；第 2 天：14.7（SD=7.1）比 38.0（SD=21.7），P<0.001）在前两天都更高。然而，ESPB 组患者的平均住院时间缩短了近一天（3.78（SD=0.82）比 2.90（SD=0.87），P<0.001），他们在出院时导管仍在位，通常在术后 5-7 天取出。
因此，超声引导 ESPB 是 Nuss 修复术后疼痛管理中 TEA 的一种可行、安全且有效的替代方法，可缩短住院时间。
III 级
