竖脊肌平面阻滞与经肌腰方肌阻滞对全腹腔镜子宫切除术后阿片类药物消耗的影响：一项随机对照临床试验
Effects of Erector Spinae Plane Block and Transmuscular Quadratus Lumborum Block on Postoperative Opioid Consumption in Total Laparoscopic Hysterectomy: A Randomized Controlled Clinical Trial.
作者信息
Jiang Weiwei, Wang Min, Wang Xiaoli, Jin Shiyun, Zhang Miao, Zhang Lili, Zhang Ye, Wu Yun
机构信息
Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, Anhui, China.
出版信息
Pain Ther. 2023 Jun;12(3):811-824. doi: 10.1007/s40122-023-00505-1. Epub 2023 Apr 13.
INTRODUCTION
Total laparoscopic hysterectomy (TLH) is a common surgical procedure that is frequently associated with substantial postoperative pain. As part of multimodal analgesia, the erector spinae plane block (ESPB) and transmuscular quadratus lumborum block (TQLB) have been demonstrated to be effective. This study aimed to evaluate whether ESPB and TQLB reduce postoperative pain and opioid consumption after TLH.
METHODS
A total of 90 female patients undergoing TLH were randomized to receive either ESPB, TQLB, or no intervention before general anesthesia. All patients received a patient-controlled sufentanil analgesia postoperatively. Postoperative pain and sufentanil consumption were evaluated. The primary outcome was cumulative sufentanil consumption at 12 h postoperatively.
RESULTS
The cumulative sufentanil consumption at 12 h postoperatively was significantly lower in Group ESPB than in Group CON after Bonferroni correction (median [interquartile range], 0 [0, 4] μg vs. 6 [0, 10] μg; median difference = - 3; 95% confidence interval, - 6-0; P = 0.010). There were no significant differences between Group TQLB and CON (0 [0, 4] μg vs. 6 [0, 10] μg; P = 0.098) or between the two block groups (P = 1.000). When compared with Group CON, ESPB and TQLB persistently reduced pain scores until 6 and 4 h after surgery, respectively (P < 0.05). However, no significant differences were found in pain scores between the two block groups.
CONCLUSIONS
ESPB and TQLB improved the quality of multimodal analgesia for TLH. ESPB may be more favorable due to the prolonged period of analgesia and decreased opioid consumption after TLH.
CLINICAL TRIAL REGISTRATION
Chinese Clinical Trial Registry: ChiCTR2100048165, Registry URL: http://www.chictr.org.cn/showproj.aspx?proj=129578 . Date of registration: July 4, 2021. The patient enrollment began on July 12, 2021.
引言
全腹腔镜子宫切除术（TLH）是一种常见的外科手术，术后常伴有明显疼痛。作为多模式镇痛的一部分，竖脊肌平面阻滞（ESPB）和经肌肉腰方肌阻滞（TQLB）已被证明是有效的。本研究旨在评估ESPB和TQLB是否能减轻TLH术后疼痛并减少阿片类药物的使用。
方法
总共90例行TLH的女性患者在全身麻醉前被随机分为接受ESPB、TQLB或不进行干预。所有患者术后均接受患者自控舒芬太尼镇痛。评估术后疼痛和舒芬太尼用量。主要结局是术后12小时的舒芬太尼累积用量。
结果
经Bonferroni校正后，ESPB组术后12小时的舒芬太尼累积用量显著低于对照组（中位数[四分位间距]，0[0,4]μg对6[0,10]μg；中位数差值=-3；95%置信区间，-6至0；P=0.010）。TQLB组与对照组之间无显著差异（0[0,4]μg对6[0,10]μg；P=0.098），两个阻滞组之间也无显著差异（P=1.000）。与对照组相比，ESPB和TQLB分别在术后6小时和4小时之前持续降低疼痛评分（P<0.05）。然而，两个阻滞组之间的疼痛评分无显著差异。
结论
ESPB和TQLB改善了TLH多模式镇痛的质量。由于TLH术后镇痛时间延长且阿片类药物用量减少，ESPB可能更具优势。
临床试验注册
中国临床试验注册中心：ChiCTR2100048165，注册网址：http://www.chictr.org.cn/showproj.aspx?proj=129578 。注册日期：2021年7月4日。患者入组于2021年7月12日开始。
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