腹腔镜胆囊切除术后镇痛的单侧右侧超声引导竖脊肌平面阻滞：一项随机对照试验
Unilateral Right-Sided Ultrasound-Guided Erector Spinae Plane Block for Post-Laparoscopic Cholecystectomy Analgesia: A Randomized Control Trial.
作者信息
Rahimzadeh Poupak, Faiz Seyed Hamid Reza, Salehi Sajede, Imani Farnad, Mueller Ariel L, Sabouri A Sassan
机构信息
Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran.
Minimally Invasive Surgery Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran.
出版信息
Anesth Pain Med. 2022 Dec 25;12(6):e132152. doi: 10.5812/aapm-132152. eCollection 2022 Dec.
BACKGROUND
Post-laparoscopic cholecystectomy (LC) pain control is still an issue postoperatively.
OBJECTIVES
We investigated the effectiveness of the unilateral right-side ultrasound-guided erector spinae plane block (ESPB) on post-LC pain intensity and opioid consumption.
METHODS
This is a parallel-arm randomized control trial on 62 adult patients with an American Society of Anesthesiologists (ASA) physical status ≤ 2 who underwent LC. The patients were randomized into 2 groups (the block group [BG] and the control group [CG]; n = 31 per group). BG received a single-shot right-sided T7 ESPB with 20 mL of 0.2% ropivacaine at arrival time in the post-anesthesia care unit (PACU). CG) received no regional anesthesia. Both groups received patient-controlled intravenous fentanyl and rescue meperidine for analgesia. The primary outcome was the pain intensity determined using a Numerical Rating Scale (NRS) in the first 24 hours after surgery. Secondary outcomes included total fentanyl and meperidine consumption within 24 hours.
RESULTS
Median pain scores were significantly higher in CG at rest and with coughing up to 12 hours after surgery compared with BG. Pain scores were higher in CG with a cough at 24 hours compared with BG (median 1 [interquartile range (IQR) 1, 2] vs. 1 [1, 0]; P = 0.0005). Total fentanyl consumption and meperidine consumption within 24 hours were significantly lower in BG compared with CG (median 60 µg [IQR 60, 90] vs 250 µg [90, 300]; P < 0.0001 and median 20 µg [IQR 10, 20] vs 25 [20, 25]; P = 0.002, respectively).
CONCLUSIONS
A single-shot, right-sided, unilateral ESPB decreases post-LC opioid consumption and pain.
背景
腹腔镜胆囊切除术后（LC）的疼痛控制仍是术后的一个问题。
目的
我们研究了单侧右侧超声引导下竖脊肌平面阻滞（ESPB）对LC术后疼痛强度和阿片类药物消耗量的有效性。
方法
这是一项针对62例美国麻醉医师协会（ASA）身体状况≤2级且接受LC手术的成年患者的平行组随机对照试验。患者被随机分为2组（阻滞组[BG]和对照组[CG]；每组n = 31）。BG在到达麻醉后护理单元（PACU）时接受单次右侧T7 ESPB，注射20 mL 0.2%罗哌卡因。CG未接受区域麻醉。两组均接受患者自控静脉注射芬太尼和补救性哌替啶用于镇痛。主要结局是术后头24小时使用数字评分量表（NRS）确定的疼痛强度。次要结局包括24小时内芬太尼和哌替啶的总消耗量。
结果
与BG相比，术后至12小时，CG在静息和咳嗽时的疼痛评分中位数显著更高。与BG相比，CG在24小时咳嗽时的疼痛评分更高（中位数1[四分位间距（IQR）1, 2] vs. 1[1, 0]；P = 0.0005）。与CG相比，BG在24小时内的芬太尼总消耗量和哌替啶消耗量显著更低（中位数60μg[IQR 60, 90] vs 250μg[90, 300]；P < 0.0001，以及中位数20μg[IQR 10, 20] vs 25[20, 25]；P = 0.002）。
结论
单次右侧单侧ESPB可减少LC术后阿片类药物的消耗量和疼痛。
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