Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA; Department of Anesthesiology and Reanimation, University of Health Science, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, TURKEY.
Department of Thoracic Surgery, University of Health Science, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, TURKEY, 34147.
J Cardiothorac Vasc Anesth. 2022 Oct;36(10):3833-3840. doi: 10.1053/j.jvca.2022.06.001. Epub 2022 Jun 6.
OBJECTIVE(S): Compared to the open surgical technique, the minimally invasive repair of pectus excavatum (MIRPE; Nuss procedure) is a thoracoscopic technique designed to minimize intraoperative tissue damage. It still causes severe postoperative pain due to the insertion and pressure of the retrosternal bar used to raise the sternum and stabilize the chest. This study aimed to identify associations between ultrasound-guided PECS-II block and postoperative analgesia after the Nuss procedure.
A retrospective cohort study SETTING: Single-center, training and research hospital affiliated with a university PARTICIPANTS: From Jan 1, 2018 to Nov 15, 2021, 171 consecutive patients were identified who underwent MIRPE surgery under general anesthesia. All patients received intravenous (I) patient-controlled analgesia (PCA) with or without PECS-II blocks for postoperative analgesia. One hundred twenty-five patients who met the inclusion criteria were evaluated.
Demand-only morphine intravenous PCA was used for postoperative pain management in the PECS and control groups. Bilateral PECS-II block with 0.25% bupivacaine was performed in to the PECS group.
The primary outcome was postoperative opioid consumption, calculated as mg/kg of IV morphine. Secondary outcomes included Numeric Rating Scale (NRS) pain scores at rest (static) and with movement (dynamic) recorded 1, 4, 8, 12, 24 h after surgery. Postoperative morphine consumption was significantly lower in the PECS group than in the control group over the first 24 hours postoperatively: 0.325 mg/kg vs. 0.425 mg/kg (p<0.001). Static and dynamic NRS values were significantly lower in the PECS group for the first 12 postoperative hours (p <0.05).
Bilateral PECS-II block is associated with decreased pain scores for up to 12 hours, and with decreased opioid consumption for up to 24 hours, following minimally invasive repair of pectus excavatum (Nuss procedure) in adolescents. PECS-II block in this context has not been previously described.
与开放式手术相比，微创漏斗胸修复术（MIRPE；Nuss 手术）是一种旨在最大程度减少术中组织损伤的胸腔镜技术。由于胸骨抬高和胸部稳定所使用的胸骨后杆的插入和压力，仍会引起严重的术后疼痛。本研究旨在确定超声引导下 PECS-II 阻滞与 Nuss 手术后的术后镇痛之间的关联。
回顾性队列研究
单中心，大学附属医院的培训和研究医院
从 2018 年 1 月 1 日至 2021 年 11 月 15 日，确定了 171 例连续接受全身麻醉下 MIRPE 手术的患者。所有患者均接受静脉（I）患者自控镇痛（PCA），无论是否进行 PECS-II 阻滞，以进行术后镇痛。评估了符合纳入标准的 125 名患者。
按需静脉注射吗啡 PCA 用于 PECS 和对照组的术后疼痛管理。在 PECS 组中进行双侧 PECS-II 阻滞，用 0.25%布比卡因阻滞。
主要结果是术后阿片类药物的消耗量，计算为 IV 吗啡的 mg/kg。次要结果包括术后 1、4、8、12 和 24 小时记录的静息（静态）和运动（动态）状态下的数字评分量表（NRS）疼痛评分。与对照组相比，PECS 组在术后 24 小时内的吗啡消耗量明显降低：0.325mg/kg 与 0.425mg/kg（p<0.001）。在术后 12 小时内，PECS 组的静态和动态 NRS 值明显更低（p<0.05）。
在青少年微创漏斗胸修复术（Nuss 手术）后，双侧 PECS-II 阻滞可使疼痛评分降低长达 12 小时，并使阿片类药物消耗减少长达 24 小时。在此背景下，PECS-II 阻滞尚未被描述。
