Huang Xin, Wang Jiao, Zhang Juntao, Kang Yi, Sandeep Bhushan, Yang Jing
Department of Anaesthesiology, West China Hospital of Sichuan University, Sichuan Province, Chengdu, China; National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Sichuan Province, Chengdu, China.
Department of Anaesthesiology, Sichuan Mianyang 404 Hospital, Sichuan Province, Mianyang, China.
Br J Anaesth. 2022 Sep;129(3):445-453. doi: 10.1016/j.bja.2022.05.013. Epub 2022 Jul 6.
Laparoscopic hepatectomy is associated with trauma and severe pain. We examined whether bilateral, ultrasound-guided, single-injection erector spinae plane block (ESPB) could improve on postoperative analgesia compared with patient-controlled intravenous analgesia in patients undergoing laparoscopic hepatectomy.
Fifty adults were randomly allocated to receive patient-controlled intravenous analgesia alone or combined with bilateral single-injection ESPB (ropivacaine 0.5%, 15 ml on each side). Primary outcome was resting pain scores at 3 h postoperatively assessed with visual analogue scale (VAS). Secondary outcomes included VAS scores at rest and during movement at 6, 12, 16, 20, 24, 48, and 72 h postoperatively; use of intraoperative opioids; postoperative rescue analgesia; sleep quality; time of first ambulation; ESPB-related complications; and ropivacaine concentration in plasma.
The ESPB group showed lower resting VAS scores at 3 h postoperatively (mean [standard deviation]), 2.0 (0.5) vs 4.3 (0.7), P<0.001, and significantly lower scores at rest and during movement at 6-24 h postoperatively. The ESPB group showed lower intraoperative opioid use, lower consumption of rescue analgesia within 72 h postoperatively, and better sleep quality. ESPB subjects began to ambulate 10 h earlier than control subjects. None of the ESPB subjects showed ESPB-related complications, and analysis of a subset of subjects showed that ropivacaine concentrations in plasma decreased gradually over time.
Compared with patient-controlled intravenous analgesia only, preoperative ultrasound-guided erector spinae plane block can improve postoperative analgesia, reduce opioid demand, and accelerate recovery in patients undergoing laparoscopic hepatectomy.
Chinese Clinical Trial Registry ChiCTR1900020961.
腹腔镜肝切除术会带来创伤和严重疼痛。我们研究了在接受腹腔镜肝切除术的患者中，与患者自控静脉镇痛相比，双侧超声引导下单次注射竖脊肌平面阻滞（ESPB）是否能改善术后镇痛效果。
50名成年人被随机分配，分别单独接受患者自控静脉镇痛或联合双侧单次注射ESPB（0.5%罗哌卡因，每侧15毫升）。主要结局指标是术后3小时用视觉模拟量表（VAS）评估的静息疼痛评分。次要结局指标包括术后6、12、16、20、24、48和72小时的静息和活动时的VAS评分；术中阿片类药物的使用；术后补救性镇痛；睡眠质量；首次下床活动时间；ESPB相关并发症；以及血浆中罗哌卡因浓度。
ESPB组术后3小时的静息VAS评分较低（均值[标准差]），分别为2.0（0.5）和4.3（0.7），P<0.001，且术后6至24小时的静息和活动时评分显著更低。ESPB组术中阿片类药物使用量更少，术后72小时内补救性镇痛的消耗量更低，睡眠质量更好。接受ESPB的患者比对照组患者提前10小时开始下床活动。接受ESPB的患者均未出现ESPB相关并发症，对一部分患者的分析表明血浆中罗哌卡因浓度随时间逐渐降低。
与仅采用患者自控静脉镇痛相比，术前超声引导下竖脊肌平面阻滞可改善腹腔镜肝切除术后的镇痛效果，减少阿片类药物需求，并加速患者康复。
中国临床试验注册中心ChiCTR1900020961
