Sun Lisa Y, Basireddy Shruthi, Gerber Lynn Ngai, Lamano Jason, Costouros John, Cheung Emilie, Boublik Jan, Horn Jean Louis, Tsui Ban C H
Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA.
Loyola University Chicago, Stritch School of Medicine, Maywood, USA.
Can J Anaesth. 2022 May;69(5):614-623. doi: 10.1007/s12630-022-02216-1. Epub 2022 Mar 2.
The high-thoracic erector spinae plane block (HT-ESPB) has been reported as an effective analgesic modality for the shoulder region without phrenic nerve palsy. The goal of this study was to compare the HT-ESPB as a phrenic nerve-sparing alternative to an interscalene block for total shoulder arthroplasty.
Thirty patients undergoing total shoulder arthroplasty at Stanford Health Care (Palo Alto, CA, USA) were enrolled in a double-blind randomized controlled trial. We randomized 28 patients to receive either an interscalene or HT-ESPB perineural catheter preoperatively; 26 patients were included in the final analysis. The study was powered for the primary outcome of incidence of hemidiaphragmatic paralysis in the postanesthesia care unit (PACU). Other outcome measures included incentive spirometry volume, brachial plexus motor and sensory exams, adverse events, pain scores, and opioid consumption.
The incidence of hemidiaphragmatic paralysis in the HT-ESPB catheter group was significantly lower than in the interscalene catheter group (0/12, 0% vs 14/14, 100%; P < 0.001). No statistically significant differences were found in pain scores and opioid consumption (in oral morphine equivalents) between the interscalene and HT-ESPB groups through postoperative day (POD) 2. Nevertheless, the mean (standard deviation) point estimates for opioid consumption for the HT-ESPB group were higher than for the interscalene group in the PACU (HT-ESPB: 24.8 [26.7] mg; interscalene: 10.7 [21.7] mg) and for POD 0 (HT-ESPB: 20.5 [25.0] mg; interscalene: 6.7 [12.0] mg). In addition, cumulative postoperative opioid consumption was significantly higher at POD 0 (PACU through POD 0) in the HT-ESPB group (45.3 [39.9] mg) than in the interscalene group (16.6 [21.9] mg; P = 0.04).
This study suggests that continuous HT-ESPB can be a phrenic nerve-sparing alternative to continuous interscalene brachial plexus blockade, although the latter provided superior opioid-sparing in the immediate postoperative period. This was a small sample size study, and further investigations powered to detect differences in analgesic and quality of recovery score endpoints are needed.
www.
gov (NCT03807505); registered 17 January 2019.
高胸段竖脊肌平面阻滞（HT-ESPB）已被报道为一种用于肩部区域且不会导致膈神经麻痹的有效镇痛方式。本研究的目的是比较HT-ESPB作为一种保留膈神经的方法，与肌间沟阻滞用于全肩关节置换术的效果。
30例在美国斯坦福医疗保健中心（加利福尼亚州帕洛阿尔托）接受全肩关节置换术的患者被纳入一项双盲随机对照试验。我们将28例患者随机分为两组，术前分别接受肌间沟或HT-ESPB神经周围导管置入；26例患者纳入最终分析。该研究的主要观察指标为麻醉后护理单元（PACU）中半侧膈肌麻痹的发生率。其他观察指标包括激励肺活量测定、臂丛神经运动和感觉检查、不良事件、疼痛评分及阿片类药物消耗量。
HT-ESPB导管组半侧膈肌麻痹的发生率显著低于肌间沟导管组（0/12，0% 对比 14/14，100%；P < 0.001）。在术后第2天之前，肌间沟组和HT-ESPB组之间的疼痛评分及阿片类药物消耗量（以口服吗啡当量计）无统计学显著差异。然而，HT-ESPB组在PACU的阿片类药物消耗量的平均（标准差）点估计值高于肌间沟组（HT-ESPB：24.8 [26.7] mg；肌间沟：10.7 [21.7] mg），术后第0天也是如此（HT-ESPB：20.5 [25.0] mg；肌间沟：6.7 [12.0] mg）。此外，HT-ESPB组术后第0天（从PACU到术后第0天）的累积阿片类药物消耗量（45.3 [39.9] mg）显著高于肌间沟组（16.6 [21.9] mg；P = 0.04）。
本研究表明，连续HT-ESPB可作为连续肌间沟臂丛神经阻滞的一种保留膈神经的替代方法，尽管后者在术后即刻具有更好的阿片类药物节省效果。这是一项小样本研究，需要进一步开展有足够效力以检测镇痛和恢复质量评分终点差异的研究。
www.
gov（NCT03807505）；2019年1月17日注册。
