超声引导下单次竖脊肌平面阻滞用于胸腔镜楔形切除术的疗效：一项前瞻性随机对照试验。

Efficacy of ultrasound-guided single-injection erector spinae plane block for thoracoscopic wedge resection: a prospective randomized control trial.

机构信息

Department of Anesthesiology and Perioperative Care, Vancouver General Hospital, Vancouver, British Columbia, Canada

Department of Anesthesiology and Perioperative Care, Vancouver General Hospital, Vancouver, British Columbia, Canada.

出版信息

Reg Anesth Pain Med. 2022 Dec;47(12):749-754. doi: 10.1136/rapm-2022-103602. Epub 2022 Sep 23.

DOI:10.1136/rapm-2022-103602

PMID:36150741

Abstract

BACKGROUND

Despite advances in minimally invasive thoracic surgery, patients remain at risk of adverse pulmonary events with suboptimal postoperative analgesia. Novel methods of regional analgesia are warranted. Our objective was to prospectively evaluate the impact of ultrasound-guided single-injection erector spinae plane (ESP) block with ropivacaine compared with placebo control on standard of care postoperative recovery in subjects undergoing video-assisted thoracoscopic surgery (VATS) wedge resection.

METHODS

This prospective, randomized, placebo-controlled, double-blinded study was conducted at a tertiary thoracic surgical center. Consecutive subjects undergoing VATS wedge resection were randomized to receive a single-injection ESP block with 0.5% ropivacaine or 0.9% saline placebo, in addition to the current standard of care of multimodal analgesia including patient-controlled analgesia and surgical local anesthetic wound infiltration. The primary outcome was difference in 40-point Quality of Recovery (QoR-40) on day 1 postoperatively. The secondary outcomes included opioid consumption, Visual Analog Pain Scale (VAS) score, time spent in the postanesthesia care unit (PACU), and block-related and postoperative complications.

RESULTS

Eighty subjects were enrolled, 40 in each group, with 76 completing follow-up (38 subjects in each group). There was no difference in the median QoR-40 score between groups, 169.5 for the ropivacaine group and 172.5 for the control group (difference 3, p=0.843). No significant differences existed between groups in all secondary outcomes, with the exception of the ropivacaine group having lower VAS pain scores measured at 1 hour postoperatively and a shorter duration of stay in the PACU of 117 min.

CONCLUSIONS

Following VATS wedge resection, the addition of an ESP block with ropivacaine to standard multimodal analgesia is unlikely to add meaningful clinical value.

TRIAL REGISTRATION NUMBER

NCT03419117.

摘要

背景

尽管微创胸外科取得了进展，但由于术后镇痛效果不理想，患者仍存在不良肺部事件的风险。需要新的区域镇痛方法。我们的目的是前瞻性评估超声引导下单次注射竖脊肌平面（ESP）阻滞罗哌卡因与安慰剂对照在接受电视辅助胸腔镜手术（VATS）楔形切除术的患者标准术后康复中的影响。

方法

这项前瞻性、随机、安慰剂对照、双盲研究在一家三级胸外科中心进行。连续接受 VATS 楔形切除术的患者被随机分为接受 0.5%罗哌卡因或 0.9%生理盐水安慰剂的单次注射 ESP 阻滞，以及包括患者自控镇痛和手术局部麻醉伤口浸润在内的当前多模式镇痛标准。主要结局是术后第 1 天 40 分质量恢复（QoR-40）的差异。次要结局包括阿片类药物消耗、视觉模拟疼痛量表（VAS）评分、在麻醉后护理单元（PACU）中花费的时间以及与阻滞和术后相关的并发症。

结果

共纳入 80 例患者，每组 40 例，76 例完成随访（每组 38 例）。两组间 QoR-40 评分中位数无差异，罗哌卡因组为 169.5，对照组为 172.5（差异 3，p=0.843）。除罗哌卡因组术后 1 小时 VAS 疼痛评分较低和 PACU 停留时间较短（117 分钟）外，两组间所有次要结局均无显著差异。