Jeong Heejoon, Choi Ji Won, Sim Woo Seog, Kim Duk Kyung, Bang Yu Jeong, Park Soyoon, Yeo Hyean, Kim Hara
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Korean J Pain. 2022 Jul 1;35(3):303-310. doi: 10.3344/kjp.2022.35.3.303.
Open gastrectomy causes severe postoperative pain. Therefore, we investigated the opioid-sparing effect of the ultrasound-guided bilateral erector spinae plane block (ESPB) after open gastrectomy.
Adult patients undergoing open gastrectomy were randomly assigned to either the ESPB group (ESPB + fentanyl based intravenous patient-controlled analgesia [IV-PCA]) or a control group (fentanyl based IV-PCA only). The primary outcome was total fentanyl equivalent consumption during the first 24 hour postoperatively. Secondary outcomes were pain intensities using a numeric rating scale at the postanesthesia care unit (PACU) and at 3, 6, 12, and 24 hour postoperatively, and the amount of fentanyl equivalent consumption during the PACU stay and at 3, 6, and 12 hour postoperatively, and the time to the first request for rescue analgesia.
Fifty-eight patients were included in the analysis. There was no significant difference in total fentanyl equivalent consumption during the first 24 hour postoperatively between the two groups ( = 0.471). Pain intensities were not significantly different between the groups except during the PACU stay and 3 hour postoperatively ( < 0.001, for both). Time to the first rescue analgesia in the ward was longer in the ESPB group than the control group ( = 0.045).
Ultrasound-guided ESPB did not decrease total fentanyl equivalent consumption during the first 24 hour after open gastrectomy. It only reduced postoperative pain intensity until 3 hour postoperatively compared with the control group. Ultrasound-guided single-shot ESPB cannot provide an efficient opioid-sparing effect after open gastrectomy.
开腹胃切除术会导致严重的术后疼痛。因此，我们研究了开腹胃切除术后超声引导下双侧竖脊肌平面阻滞（ESPB）的阿片类药物节省效应。
接受开腹胃切除术的成年患者被随机分为ESPB组（ESPB + 基于芬太尼的静脉自控镇痛[IV-PCA]）或对照组（仅基于芬太尼的IV-PCA）。主要结局是术后24小时内芬太尼等效物的总消耗量。次要结局包括在麻醉后恢复室（PACU）以及术后3、6、12和24小时使用数字评分量表评估的疼痛强度，PACU停留期间以及术后3、6和12小时芬太尼等效物的消耗量，以及首次请求救援镇痛的时间。
58例患者纳入分析。两组术后24小时内芬太尼等效物的总消耗量无显著差异（ = 0.471）。除了在PACU停留期间和术后3小时外，两组之间的疼痛强度无显著差异（两者均 < 0.001）。ESPB组在病房首次救援镇痛的时间比对照组更长（ = 0.045）。
超声引导下的ESPB在开腹胃切除术后24小时内并未减少芬太尼等效物的总消耗量。与对照组相比，它仅在术后3小时内降低了术后疼痛强度。超声引导下单次ESPB在开腹胃切除术后不能提供有效的阿片类药物节省效应。
