From the Department of Anesthesia and Operating Theatre Services, Tuen Mun Hospital, Tuen Mun, Hong Kong.
Department of Anesthesiology, LKS Faculty of Medicine, the University of Hong Kong, Tuen Mun, Hong Kong.
Anesth Analg. 2022 Oct 1;135(4):829-836. doi: 10.1213/ANE.0000000000006162. Epub 2022 Aug 1.
Lumbar erector spinae plane block (ESPB) has been proposed to relieve pain after total hip replacement (THR), but high-quality evidence is scarce.
This double-blinded (patient and assessor) randomized clinical trial, performed in 2 tertiary centers in Hong Kong, recruited patients undergoing primary unilateral THR under general anesthesia (GA) who received either single-shot ESPB at L1 (treatment arm) or no block (control arm). Patients were followed up on the first day postoperatively. We hypothesized that compared to no block, a single-shot lumbar ESPB at L1 would reduce postoperative fentanyl use and postoperative pain scores. Primary outcomes were intravenous fentanyl use at 12 and 24 hours postoperatively, along with pain intensity in numeric rating scale (0-10) at rest and upon movement on the first day postoperatively. Per-protocol analysis was performed. Mann-Whitney U test was used to compare the outcomes between both groups, and median difference was derived from the Hodges-Lehmann estimator.
Seventy-one patients were randomized (n = 36 in treatment arm, n = 35 in control arm). The median amount of fentanyl consumed at 12 hours postoperatively was 210 (quartiles, 140.5-363) μg for the ESPB group and 165 (quartiles, 77.5-330.5) μg for the control group, while at 24 hours postoperatively, it was 409 (quartiles, 221-636.5) μg for the former and 349 (quartiles, 114-626.5) μg for the latter. The median differences in fentanyl consumption 12 and 24 hours postoperatively were 39 μg (95% confidence interval [CI], -40 to 116; P = .463) and 41 μg, respectively (95% CI, -83.5 to 199.5; P = .474), which were statistically insignificant. The median pain score at rest was 3 for both the ESPB group (quartiles, 0-5) and the control group (quartiles, 0-4.5), while upon movement, it was 7 for both the former (quartiles, 6-8) and the latter (quartiles, 4.5-8.5). The median difference in pain scores between both groups was 0 at rest (95% CI, -1 to 1; P = .890) and upon movement (95% CI, -1 to 1; P = .509).
This trial did not demonstrate that ESPB at L1 improved analgesia following THR.
腰椎竖脊肌平面阻滞（ESPB）被提议用于缓解全髋关节置换术（THR）后的疼痛，但高质量证据稀缺。
本研究为在香港 2 家三级中心进行的双盲（患者和评估者）随机临床试验，招募了在全身麻醉（GA）下接受初次单侧 THR 的患者，这些患者接受 L1 单次注射 ESPB（治疗组）或不接受阻滞（对照组）。患者在术后第 1 天进行随访。我们假设与不阻滞相比，L1 单次腰椎 ESPB 会减少术后芬太尼的使用和术后疼痛评分。主要结局是术后 12 小时和 24 小时静脉内芬太尼的使用，以及术后第 1 天静息和活动时数字评分量表（0-10）的疼痛强度。进行了意向治疗分析。采用 Mann-Whitney U 检验比较两组之间的结果，中位数差异来自 Hodges-Lehmann 估计值。
71 名患者被随机分配（治疗组 n = 36，对照组 n = 35）。术后 12 小时芬太尼的中位数消耗量为 ESPB 组 210（四分位距，140.5-363）μg，对照组为 165（四分位距，77.5-330.5）μg，术后 24 小时芬太尼的中位数消耗量为前者 409（四分位距，221-636.5）μg，后者为 349（四分位距，114-626.5）μg。术后 12 小时和 24 小时芬太尼消耗的中位数差异分别为 39μg（95%置信区间，-40 至 116；P =.463）和 41μg（95%置信区间，-83.5 至 199.5；P =.474），均无统计学意义。ESPB 组静息时的中位数疼痛评分为 3（四分位距，0-5），对照组为 3（四分位距，0-4.5），活动时的中位数疼痛评分为前者 7（四分位距，6-8），后者 7（四分位距，4.5-8.5）。两组之间静息时疼痛评分的中位数差异为 0（95%置信区间，-1 至 1；P =.890），活动时疼痛评分的中位数差异为 0（95%置信区间，-1 至 1；P =.509）。
本试验并未表明 L1 处的 ESPB 可改善 THR 后的镇痛效果。
