Department of Anesthesiology and Pain medicine, Catharina hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands; Faculty of Health, Medicine and Life Sciences, Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands.
Faculty of Health, Medicine and Life Sciences, Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands; Department of Vascular Surgery, Catharina hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands.
J Clin Anesth. 2022 Nov;82:110939. doi: 10.1016/j.jclinane.2022.110939. Epub 2022 Jul 27.
To investigate if an interpectoral-pectoserratus plane (PECS II) block decreases postoperative pain, postoperative nausea and vomiting and improves quality of recovery in patients with neurogenic thoracic outlet syndrome (NTOS) undergoing trans-axillary thoracic outlet decompression surgery.
A prospective single center double blinded randomized placebo-controlled trial.
Perioperative period; operating room, post anesthesia care unit (PACU) and hospital ward.
Seventy patients with NTOS, undergoing trans-axillary thoracic outlet decompression surgery.
Patients were randomized to an interventional arm, receiving the block with 40 ml ropivacaine 0.5% (concentration was adjusted if the patient's weight was <66 kg), and a placebo group, receiving a sham block with 40 ml NaCl 0.9%. The interpectoral-pectoserratus plane block was performed ultrasound guided; the first injection below the pectoral minor muscle and the second below the pectoral major muscle. The hospitals' pharmacist prepared the study medication and was the only person able to see the randomization result. The study was blinded for patients, researchers and medical personnel.
Primary outcome parameters were postoperative pain, measured by numeric rating scale on the PACU (start and end) and on the ward on postoperative day (POD) 0 and 1, and postoperative morphine consumption, measured on the PACU and on the ward during the first 24 h. Secondary outcome parameters were postoperative nausea and vomiting, and quality of recovery.
There was no statistically significant difference in NRS on the PACU at the start (ropivacaine 4.9 ± 3.2 vs placebo 6.2 ± 3.0, p = .07), at the end (ropivacaine 4.0 ± 1.7 vs placebo 3.9 ± 1.7, p = .77), on the ward on POD 0 (ropivacaine 4.6 ± 2.0 vs placebo 4.6 ± 2.0, p = 1.00) or POD 1 (ropivacaine 3.9 ± 1.8 vs placebo 3.6 ± 2.0, p = .53). There was no difference in postoperative morphine consumption at the PACU (ropivacaine 11.0 mg ± 6.5 vs placebo 10.8 mg ± 4.8, p = .91) or on the ward (ropivacaine 11.6 mg ± 8.5 vs placebo 9.6 mg ± 9.4, p = .39).
The interpectoral-pectoserratus plane block is not effective for postoperative analgesia in patients with NTOS undergoing trans-axillary thoracic outlet decompression surgery.
研究肋间-胸小肌平面（PECS II）阻滞是否可以减轻神经源性胸廓出口综合征（NTOS）患者接受经腋窝胸廓出口减压手术后的疼痛、术后恶心和呕吐，并改善术后恢复质量。
前瞻性单中心双盲随机安慰剂对照试验。
围手术期；手术室、麻醉后监护室（PACU）和医院病房。
70 例 NTOS 患者，行经腋窝胸廓出口减压手术。
患者随机分为干预组，接受 40ml 罗哌卡因 0.5%（如果患者体重<66kg，则调整浓度）的阻滞，以及接受 40ml NaCl 0.9%的安慰剂组。肋间-胸小肌平面阻滞采用超声引导；第一次注射在胸小肌下方，第二次注射在胸大肌下方。医院药剂师准备研究药物，是唯一能够看到随机分组结果的人。该研究对患者、研究人员和医务人员均为盲法。
主要结局参数为术后疼痛，在 PACU（开始和结束时）和术后第 0 天和第 1 天在病房测量，以及术后 24 小时内 PACU 和病房内的吗啡消耗量。次要结局参数为术后恶心和呕吐以及恢复质量。
PACU 开始时（罗哌卡因 4.9±3.2 与安慰剂 6.2±3.0，p=0.07）、结束时（罗哌卡因 4.0±1.7 与安慰剂 3.9±1.7，p=0.77）、术后第 0 天（罗哌卡因 4.6±2.0 与安慰剂 4.6±2.0，p=1.00）或第 1 天（罗哌卡因 3.9±1.8 与安慰剂 3.6±2.0，p=0.53）时，NRS 无统计学显著差异。PACU （罗哌卡因 11.0±6.5 与安慰剂 10.8±4.8，p=0.91）或病房（罗哌卡因 11.6±8.5 与安慰剂 9.6±9.4，p=0.39）之间术后吗啡消耗量也无差异。
肋间-胸小肌平面阻滞对接受经腋窝胸廓出口减压手术的 NTOS 患者术后镇痛无效。
