Demir Zeliha Asli, Aydin Muhammed Enes, Balci Eda, Ozay Hulya Yigit, Ozgok Aysegul, Ahiskalioglu Ali
Anesthesiology Department, Ankara City Hospital, Health Sciences University, Ankara, Turkey.
Department of Anaesthesiology and Reanimation, Ataturk University School of Medicine, 25070, Erzurum, Turkey.
Gen Thorac Cardiovasc Surg. 2024 Jan;72(1):1-7. doi: 10.1007/s11748-023-01953-4. Epub 2023 Jul 6.
Erector spinae plane block has been shown to help with pain management in different regions and many areas with different indications. However, the effectiveness of this block in cardiac surgery has been shown in the literature, the optimal volume remains unclear. The aim of this study is to determine the analgesic efficacy of two different volumes of local anesthetic injection used in ultrasound-guided bilateral-thoracic erector spinae plane block in patients undergoing coronary artery bypass graft.
This study was conducted on adult patients undergoing surgery with coronary artery bypass graft, and 70 patients were analyzed in each group. Group 20 received erector spinae plane block with 20 ml of 0.25% bupivacaine, Group 30 received 30 ml of 0.25% bupivacaine bilaterally. Postoperative sternotomy and chest tube-related pain were evaluated using the numerical rating scale (NRS) at rest and during movement.
There were significant differences between the groups regarding rescue tramadol consumption was higher in Group 20 than in Group 30 (25/35 vs. 2/35, p < 0.001). In addition, there were substantial differences between the two groups concerning the time of the first-rescue analgesic requirement. The mean time ± standard deviation was 11.26 ± 9.57 h and 24.03 ± 4.12 h in Groups 20 and 30 (p < 0.001). The median scores, both at sternotomy and chest tubes, were significantly lower in Group 30 than in Group 20 at the different time points after the surgery (p < 0.05).
In coronary artery bypass graft surgery, erector spinae plane block performed with 30 ml instead of 20 ml on each side resulted in less pain in the sternum and chest tube region, less need for rescue analgesics, and delayed first-rescue analgesic requirement.
竖脊肌平面阻滞已被证明在不同区域和许多不同适应症的疼痛管理中有效。然而，在心脏手术中，这种阻滞的效果已在文献中得到证实，但其最佳容量仍不清楚。本研究旨在确定超声引导下双侧竖脊肌平面阻滞中使用两种不同容量局部麻醉药注射在冠状动脉旁路移植术中的镇痛效果。
本研究纳入了行冠状动脉旁路移植术的成年患者，每组分析 70 例患者。第 20 组接受 20ml0.25%布比卡因的竖脊肌平面阻滞，第 30 组接受双侧 30ml0.25%布比卡因的竖脊肌平面阻滞。使用数字评分量表（NRS）在休息和运动时评估术后胸骨切开和胸管相关疼痛。
两组之间在以下方面存在显著差异：第 20 组的解救曲马多消耗明显高于第 30 组（25/35 比 2/35，p<0.001）。此外，两组之间在首次需要解救镇痛的时间方面存在显著差异。第 20 组和第 30 组的平均时间（±标准差）分别为 11.26±9.57 小时和 24.03±4.12 小时（p<0.001）。手术后不同时间点，第 30 组胸骨和胸管的中位数评分均明显低于第 20 组（p<0.05）。
在冠状动脉旁路移植术中，每侧使用 30ml 而不是 20ml 进行竖脊肌平面阻滞可使胸骨和胸管区域疼痛减轻，需要解救镇痛的次数减少，首次需要解救镇痛的时间延迟。
