Yuan Zhihao, Liu Jinzhu, Jiao Kun, Fan Ying, Zhang Yanjun
Department of Anesthesiology, Tianjin Children's Hospital, Tianjin, China.
Operating Room, Tianjin Children's Hospital, Tianjin, China.
Transl Pediatr. 2022 May;11(5):706-714. doi: 10.21037/tp-22-118.
Pediatric patients often experience severe pain after thoracic surgery, especially in the early postoperative period. Recently, the focus has been on regional analgesia with the introduction of ultrasound-guided erector spinae plane blocks. We assumed that preoperative erector spinae plane block (ESPB) in children undergoing video-assisted thoracoscopic surgery (VATS) would reduce the consumption of perioperative opioids.
This randomized, double-blind study enrolled 60 children aged 1-3 years who underwent thoracoscopic lung lesion resection. The patients were enrolled in the study and randomly divided into two groups. The general anesthesia (GA) group received GA alone, and the GA + ESPB group received ESPB. The consumptions of remifentanil and sufentanil were recorded, and the children's face, legs, activity, cry, consolability (FLACC) scores were assessed after awakening. The time to first rescue analgesia, length of hospital stay, parental satisfaction and adverse events were also recorded.
The consumptions of remifentanil and sufentanil in the GA + ESPB group were significantly lower than those in the GA group, mean difference [95% confidence interval (CI)]: -26.57 (-31.98 to -21.17) and -0.21 (-0.27 to -0.17), respectively, (both P<0.001); while the time to first rescue analgesia and parental satisfaction scores were significantly longer and higher, respectively, in the GA + ESPB group than those in the GA group, mean difference (95% CI): 2.37 (1.77 to 2.97) and 2.47 (1.79 to 3.15), respectively, (both P<0.001). The FLACC scores in the GA + ESPB group were significantly lower than those in the GA group 1 to 24 hours postoperatively (P=0.023 at 1 h, and P<0.001 at 3 h, 6 h, 12 h, 18 h, 24 h), but not at immediate admission to the post-anesthesia care unit (PACU) (P=0.189 at 0 h). The GA + ESPB group had significantly lower incidence rates of postoperative nausea and vomiting (P=0.037 and P=0.020).
In pediatric Thoracoscopic surgery, the results of this study confirm our hypothesis that ESPB decreases the consumptions of intraoperative remifentanil and postoperative sufentanil in 24 hours and demonstrates better postoperative analgesia compared with a control group.
Chinese Clinical Trial Registry ChiCTR2200056166.
小儿患者在胸科手术后常经历严重疼痛，尤其是在术后早期。近年来，随着超声引导下竖脊肌平面阻滞的引入，区域镇痛成为关注焦点。我们推测，接受电视辅助胸腔镜手术（VATS）的儿童术前进行竖脊肌平面阻滞（ESPB）可减少围手术期阿片类药物的使用。
本随机双盲研究纳入60例1 - 3岁接受胸腔镜肺病变切除术的儿童。患者入组后随机分为两组。全身麻醉（GA）组仅接受全身麻醉，GA + ESPB组接受ESPB。记录瑞芬太尼和舒芬太尼的用量，并在患儿苏醒后评估其面部、腿部、活动、哭闹、安慰度（FLACC）评分。还记录首次补救镇痛时间、住院时间、家长满意度及不良事件。
GA + ESPB组瑞芬太尼和舒芬太尼的用量显著低于GA组，平均差值[95%置信区间（CI）]分别为 -26.57（-31.98至 -21.17）和 -0.21（-0.27至 -0.17），（均P<0.001）；而GA + ESPB组首次补救镇痛时间显著长于GA组，家长满意度评分显著高于GA组，平均差值（95%CI）分别为2.37（1.77至2.97）和2.47（1.79至3.15），（均P<0.001）。GA + ESPB组术后1至24小时的FLACC评分显著低于GA组（术后1小时P = 0.023，术后3小时、6小时、12小时、18小时、24小时P<0.001），但在进入麻醉后护理单元（PACU）即刻无差异（术后0小时P = 0.189）。GA + ESPB组术后恶心呕吐的发生率显著更低（P = 0.037和P = 0.020）。
在小儿胸腔镜手术中，本研究结果证实了我们的假设，即ESPB可减少术中瑞芬太尼用量及术后24小时舒芬太尼用量，且与对照组相比术后镇痛效果更佳。
中国临床试验注册中心ChiCTR2200056166。
