Department of Anesthesiology and Perioperative Medicine, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China.
Department of Anesthesiology and Perioperative Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Minerva Anestesiol. 2023 Jun;89(6):520-528. doi: 10.23736/S0375-9393.22.16794-5. Epub 2023 Jan 24.
Thoracic paravertebral block offers effective analgesia after laparoscopic nephrectomy but has potential severe complication risks. Erector spinae plane block has been described for analgesia after abdominal surgery. However, there are no prospective randomized trials determining if ultrasound-guided erector spinae plane block is non-inferior to thoracic paravertebral block in terms of analgesia after abdominal surgeries including laparoscopic nephrectomy.
Sixty-six patients scheduled for laparoscopic nephrectomy were randomized in a 1:1 ratio to receive ultrasound-guided erector spinae plane block (erector spinae plane block group) or thoracic paravertebral block (thoracic paravertebral block group) with 25 mL 0.5% ropivacaine. The primary outcome of this non-inferiority study was the average numerical rating scale score at rest within the first 24 hours following surgery. Secondary outcomes included numerical rating scale scores at rest and while coughing at one, six, 12, 24 and 48 hours postoperatively, total press times of patient-controlled analgesia, time to first press of patient-controlled analgesia, pain rescue, puncture time, the first-attempt success rate to puncture, worst numerical rating scale score during block, dermatomal distribution of sensory blockade, postoperative nausea and vomiting scores, quality of recovery score and time to flatus.
Sixty-one subjects, 30 from the erector spinae plane block group and 31 from the thoracic paravertebral block group, completed the study. The median difference (erector spinae plane block minus thoracic paravertebral block) in the primary outcome was 0 (95% CI: 0 to 1). The 95% CI upper limit did not exceed the non-inferiority margin of 1. Numerical rating scale scores at rest at 12 hours and while coughing at six and 12 hours postoperatively were statistically lower in the thoracic paravertebral block group (P=0.04, 0.04 and P<0.05, respectively). There was a shorter puncture time (42.1 s vs. 56.8 s), higher success rate of the first attempt to puncture (83% vs. 58%) and lower pain score during block (2 vs. 3) in the erector spinae plane block group. Other secondary outcomes were similar between groups.
This study demonstrates that erector spinae plane block provides non-inferior analgesia for pain at rest within 24 postoperative hours in comparison to thoracic paravertebral block for laparoscopic nephrectomy.
胸椎旁神经阻滞可为腹腔镜肾切除术后提供有效的镇痛效果，但存在潜在的严重并发症风险。竖脊肌平面阻滞已被用于腹部手术后的镇痛。然而，目前还没有前瞻性随机试验确定在腹部手术后（包括腹腔镜肾切除术后），超声引导下竖脊肌平面阻滞在镇痛效果方面是否不劣于胸椎旁神经阻滞。
66 例拟行腹腔镜肾切除术的患者被随机分为 1:1 比例的两组，分别接受超声引导下竖脊肌平面阻滞（竖脊肌平面阻滞组）或胸椎旁神经阻滞（胸椎旁神经阻滞组），每组 25mL0.5%罗哌卡因。本非劣效性研究的主要结局为术后 24 小时内静息状态下的平均数字评分量表评分。次要结局包括术后 1、6、12、24 和 48 小时静息和咳嗽时的数字评分量表评分、患者自控镇痛按压次数、首次按压患者自控镇痛的时间、疼痛补救、穿刺时间、首次穿刺成功率、阻滞时最差的数字评分量表评分、感觉阻滞的皮节分布、术后恶心和呕吐评分、恢复质量评分和排气时间。
61 例患者（竖脊肌平面阻滞组 30 例，胸椎旁神经阻滞组 31 例）完成了研究。主要结局的中位数差值（竖脊肌平面阻滞组减去胸椎旁神经阻滞组）为 0（95%置信区间：0 至 1）。95%置信区间上限未超过 1 的非劣效性边界。术后 12 小时静息和 6 小时、12 小时咳嗽时的数字评分量表评分在胸椎旁神经阻滞组中统计学上较低（P=0.04、0.04 和 P<0.05，分别）。竖脊肌平面阻滞组的穿刺时间更短（42.1 秒对 56.8 秒），首次穿刺成功率更高（83%对 58%），阻滞时疼痛评分更低（2 对 3）。其他次要结局在两组之间相似。
本研究表明，与胸椎旁神经阻滞相比，竖脊肌平面阻滞可为腹腔镜肾切除术后 24 小时内静息状态下的疼痛提供非劣效的镇痛效果。
Zotero 插件