Kodali V Rajesh Kumar, Shree Shruthi, Prasad Mahender, Sambandam Kamala Kannan G, Karthekeyan Ranjith B, Vakamudi Mahesh
Department of Anaesthesiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India.
Department of Cardiac Anaesthesiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India.
J Cardiothorac Vasc Anesth. 2022 Nov;36(11):4085-4092. doi: 10.1053/j.jvca.2022.07.015. Epub 2022 Jul 16.
Regional analgesia, along with general anesthesia, reduce postoperative pain. In this study, the authors compared the erector spinae plane (ESP) block having dexmedetomidine as an adjuvant with conventional pain management along with intravenous dexmedetomidine.
Prospective randomized single-blinded trial.
Tertiary care teaching hospital.
All of the patients scheduled for elective off-pump coronary artery bypass grafting with an ejection fraction of >45%.
After obtaining institutional ethical committee approval, 130 patients were randomized into Group E and Group D. Group E patients received ESP block bilaterally with 25 mL of bupivacaine plus 0.5 μg/kg of dexmedetomidine. The patients in Group D received conventional intravenous analgesia, as well as a 0.7 μg/kg of dexmedetomidine bolus, followed by a 0.3 μg/kg dexmedetomidine infusion during surgery and continued postoperatively for 24 hours. Group E patients received 8 mL/h of bupivacaine infusion bilaterally for 24 hours.
The primary outcome assessed was pain scores in the postoperative period. The secondary outcomes assessed were postoperative rescue analgesic consumption, time to first rescue analgesia, intraoperative fentanyl consumption, duration of mechanical ventilation, and duration of intensive care unit (ICU) stay.
Both groups were comparable in demographic characteristics. The postoperative pain scores from 4 hours to 12 hours were lower in Group E compared with Group D. The pain scores at 24 hours were not significantly different between groups. Postoperative fentanyl consumption in Group E (99.23 ± 50.19 μg) was significantly lower than in Group D (181.15 ± 82.92 μg), with a p value of 0.001. Time to first rescue analgesia was significantly longer in Group E, with a median score of 8 hours when compared with that of 4 hours in Group D, with a p value of 0.01. Intraoperative fentanyl consumption was significantly lower in Group E (392.15 ± 55.36 μg) compared with Group D (604.00 ± 131.87 μg; p = 0.001). There were no significant differences in the duration of mechanical ventilation in both groups. Duration of ICU stay was significantly lower in Group E (51.95 ± 8.54 hours) when compared with Group D (59.06 ± 8.68 hours) (p = 0.001).
Erector spinae fascial plane blocks appeared to reduce postoperative pain scores in off-pump coronary artery bypass graft patients. Furthermore, ESP block was beneficial in terms of less intraoperative and postoperative opioid consumption, longer time to first rescue analgesia, and shorter ICU stay.
区域镇痛与全身麻醉一起可减轻术后疼痛。在本研究中，作者比较了以右美托咪定为辅助剂的竖脊肌平面（ESP）阻滞与常规疼痛管理联合静脉注射右美托咪定的效果。
前瞻性随机单盲试验。
三级护理教学医院。
所有计划进行择期非体外循环冠状动脉搭桥术且射血分数>45%的患者。
获得机构伦理委员会批准后，130例患者被随机分为E组和D组。E组患者双侧接受25 mL布比卡因加0.5 μg/kg右美托咪定的ESP阻滞。D组患者接受常规静脉镇痛，以及0.7 μg/kg右美托咪定推注，随后在手术期间以0.3 μg/kg右美托咪定输注，并在术后持续24小时。E组患者双侧接受8 mL/h布比卡因输注，持续24小时。
评估的主要结局是术后疼痛评分。评估的次要结局是术后补救性镇痛药消耗量、首次使用补救性镇痛药的时间间隔、术中芬太尼消耗量、机械通气持续时间和重症监护病房（ICU）住院时间。
两组在人口统计学特征方面具有可比性。与D组相比，E组术后4小时至12小时的疼痛评分较低。两组在24小时时的疼痛评分无显著差异。E组术后芬太尼消耗量（99.23±50.19 μg）显著低于D组（181.15±82.92 μg），p值为0.001。E组首次使用补救性镇痛药的时间间隔显著更长，中位时间为8小时，而D组为4小时，p值为0.01。与D组（604.00±131.87 μg；p =0.001）相比，E组术中芬太尼消耗量显著更低（392.15±55.36 μg）。两组机械通气持续时间无显著差异。与D组（59.06±8.68小时）相比，E组ICU住院时间显著更短（51.95±8.54小时）（p =0.001）。
竖脊肌筋膜平面阻滞似乎可降低非体外循环冠状动脉搭桥术患者的术后疼痛评分。此外，ESP阻滞在减少术中和术后阿片类药物消耗量、延长首次使用补救性镇痛药的时间间隔以及缩短ICU住院时间方面有益。
