University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey.
University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey.
J Cardiothorac Vasc Anesth. 2022 Aug;36(8 Pt B):2991-2999. doi: 10.1053/j.jvca.2022.01.048. Epub 2022 Feb 4.
The study aimed to compare the analgesic effects of erector spinae plane block (ESPB) and a combination of the deep and superficial serratus anterior plane block (C-SAPB) methods in patients who underwent video-assisted thoracoscopic surgery (VATS).
A prospective, randomized study.
At a single-center, high-volume, tertiary thoracic surgery center.
Adult patients undergoing VATS.
Ultrasound-guided ESPB and C-SAPB.
Patients were assigned to ESPB (group 1) or C-SAPB (group 2) groups according to the analgesia protocol. All interventions were performed with single-needle insertion. Multimodal analgesia was achieved via paracetamol, dexketoprofen, and intravenous morphine for both study groups. Pain scores were assessed by the visual analog scale (VAS). Morphine consumption, rescue analgesic requirements, and side effects were recorded postoperatively for 24 hours. The primary outcome was determined as VAS scores at rest and coughing. The secondary outcomes of this study were postoperative morphine consumption and the requirement of rescue analgesics. There was no statistically significant difference between the groups in terms of VAS scores (p > 0.05). The groups also were similar in terms of demographic characteristics, side effects, morphine consumption, additional analgesic use, and duration of block procedures (p > 0.05). There also were comparable results in terms of hemodynamic variables (p > 0.05).
Patients who underwent VATS receiving ESPB or C-SAPB had similar pain scores, opioid consumption, and side effects during the first postoperative 24 hours. At the same time, the fact that the duration of the block procedure was similar in both groups showed that multisite serratus anterior plane block can be an effective alternative method in analgesic treatment after VATS, considering that it easily can be applied. The authors here think that C-SAPB can be a good alternative to ESPB because the outcomes of both applications are similar, and C-SAPB easily can be seen and applied with ultrasound.
本研究旨在比较竖脊肌平面阻滞（ESPB）与深、浅侧锯肌平面阻滞（C-SAPB）联合应用于电视辅助胸腔镜手术（VATS）患者的镇痛效果。
前瞻性、随机研究。
在一家单中心、大容量、三级胸外科中心。
接受 VATS 的成年患者。
超声引导下的 ESPB 和 C-SAPB。
根据镇痛方案将患者分配到 ESPB（第 1 组）或 C-SAPB（第 2 组）组。所有干预均采用单针插入。两组均采用对乙酰氨基酚、右旋酮洛芬和静脉吗啡进行多模式镇痛。术后 24 小时内记录视觉模拟评分（VAS）、吗啡用量、解救性镇痛需求和不良反应。主要结局为静息和咳嗽时的 VAS 评分。本研究的次要结局为术后吗啡用量和解救性镇痛需求。两组间 VAS 评分（p＞0.05）无统计学差异。两组在人口统计学特征、不良反应、吗啡用量、额外镇痛使用和阻滞程序持续时间方面也相似（p＞0.05）。在血流动力学变量方面也有类似的结果（p＞0.05）。
接受 VATS 的患者在术后 24 小时内接受 ESPB 或 C-SAPB 时，疼痛评分、阿片类药物消耗和不良反应相似。同时，两组阻滞程序持续时间相似，表明多部位前锯肌平面阻滞在 VATS 后镇痛治疗中是一种有效的替代方法，因为它易于实施。作者认为 C-SAPB 可以替代 ESPB，因为两种应用的结果相似，而且 C-SAPB 可以通过超声清晰地看到和应用。
