程序化间歇性推注输注与持续输注用于电视辅助胸腔镜手术中竖脊肌平面阻滞的比较：一项双盲随机对照试验

Programmed intermittent bolus infusion vs. continuous infusion for erector spinae plane block in video-assisted thoracoscopic surgery: A double-blinded randomised controlled trial.

作者信息

Taketa Yasuko, Takayanagi Yuki, Irisawa Yumi, Fujitani Taro

机构信息

From the Department of Anaesthesiology and Critical Care, Ehime Prefectural Central Hospital, Matsuyama City, Japan (YT, YT, YI, TF).

出版信息

Eur J Anaesthesiol. 2023 Feb 1;40(2):130-137. doi: 10.1097/EJA.0000000000001788. Epub 2022 Dec 13.

DOI:10.1097/EJA.0000000000001788

PMID:36592009

Abstract

BACKGROUND

The optimal form of administration for erector spinae plane block has not been established.

OBJECTIVE

To compare the efficacy of programmed intermittent bolus infusion (PIB) and continuous infusion for erector spinae plane block.

DESIGN

A prospective, randomised, double-blind study.

SETTING

A single centre between June 2019 and March 2020.

PATIENTS

Included patients had an American Society of Anesthesiologists physical status 1 to 3 and were scheduled for video-assisted thoracic surgery.

INTERVENTIONS

Patients were randomised to receive continuous infusion (0.2% ropivacaine 8 ml h-1; Group C) or PIB (0.2% ropivacaine 8 ml every 2 h; Group P).

MAIN OUTCOME MEASURES

The primary outcome was the number of desensitised dermatomes in the midclavicular line, measured 21 h after first bolus injection.

RESULTS

Fifty patients were randomly assigned to each group; finally, the data of 24 and 25 patients in Group C and P, respectively, were analysed. The mean difference in the number of desensitised dermatomes in the midclavicular line at 5 and 21 h after the initial bolus administration was 1.0 [95% confidence interval (CI) 0.5 to 1.5] and 1.6 (95% CI 1.1 to 2.0), respectively, which was significantly higher in Group P than in Group C (P < 0.001). The median difference in rescue morphine consumption in the early postoperative period (0 to 24 h) was 4 (95% CI 1 to 8) mg, which was significantly lower in Group P (P = 0.035). No significant difference in the postoperative numerical rating scale score was found between the groups.

CONCLUSIONS

PIB for erector spinae plane block in video-assisted thoracic surgery resulted in a larger anaesthetised area and required a lower anaesthetic dose to maintain the analgesic effect. Therefore, it is more suitable for erector spinae plane block than continuous infusion.

TRIAL REGISTRATION

UMIN Clinical Trials Registry (UMIN-CTR, ID: UMIN000036574, Principal investigator: Taro Fujitani, 04/22/2019, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000041671).

摘要

背景

竖脊肌平面阻滞的最佳给药方式尚未确定。

目的

比较程序化间歇性推注输注（PIB）和持续输注用于竖脊肌平面阻滞的疗效。

设计

一项前瞻性、随机、双盲研究。

地点

2019年6月至2020年3月期间的一个单一中心。

患者

纳入的患者美国麻醉医师协会身体状况分级为1至3级，计划行电视辅助胸腔手术。

干预措施

患者被随机分配接受持续输注（0.2%罗哌卡因8 ml·h-1；C组）或PIB（0.2%罗哌卡因每2小时8 ml；P组）。

主要观察指标

主要观察指标是首次推注注射后21小时测量的锁骨中线处感觉减退皮节的数量。

结果

每组随机分配50例患者；最终，分别分析了C组和P组中24例和25例患者的数据。首次推注给药后5小时和21小时，锁骨中线处感觉减退皮节数量的平均差异分别为1.0[95%置信区间（CI）0.5至1.5]和1.6（95%CI 1.1至2.0），P组显著高于C组（P<0.001）。术后早期（0至24小时）补救性吗啡消耗量的中位数差异为4（95%CI 1至8）mg，P组显著更低（P = 0.035）。两组之间术后数字评定量表评分无显著差异。