Wu Shihuan, Wu Jing, Zhang Xifeng
Department of Anesthesiology, Children's Hospital of Nanjing Medical University, Nanjing, China.
Front Pediatr. 2023 Jun 28;11:1201604. doi: 10.3389/fped.2023.1201604. eCollection 2023.
To retrospectively analyze the effect of applying an ultrasound-guided bilateral erector spine plane block (ESPB) after the Nuss procedure for surgical repair of pectus excavatum (PE) in children.
The subjects of the study were patients with severe PE who received the Nuss procedure in our hospital between 1 January 2019 and 30 November 2021. According to different methods for postoperative pain management, the enrolled patients were divided into two groups, the ultrasound-guided ESPB group and the thoracic epidural analgesia (TEA) group. The primary outcome of this study was analgesic drug dosage and the secondary outcome was numerical rating scales (NRSs) between the two groups.
There was no significant difference between the two groups in terms of demographic, preoperative clinical evaluation, or surgical characteristics ( > 0.05). The catheter duration in the TEA group was significantly shorter than that in the ESPB group ( < 0.05), while the hospitalization time in the ESPB group was significantly shorter than that in the TEA group ( < 0.05). In terms of oral morphine equivalent comparison, the required dose of the TEA group was lower than that of the ESPB group on the 1st and 2nd day after the operation ( < 0.05), and there was no statistical difference between the two groups on the 3rd and 4th day after the operation ( > 0.05). The number of patients with an S-NRS ≥ 7 and D-NRS ≥ 7 in the TEA group at day 1 was lower than that in the ESPB group ( < 0.05). There was no significant difference between the two groups at other time points ( > 0.05).
An ultrasound-guided ESPB used in Nuss surgery for children with funnel chest can provide good analgesia for surgery and shorten the postoperative rehabilitation and hospitalization time of patients. It is a safe and effective alternative to TEA.
回顾性分析超声引导下双侧竖脊肌平面阻滞（ESPB）在小儿漏斗胸（PE）Nuss手术修复术后的应用效果。
研究对象为2019年1月1日至2021年11月30日在我院接受Nuss手术的重度PE患者。根据术后疼痛管理方法的不同，将入选患者分为两组，即超声引导ESPB组和胸段硬膜外镇痛（TEA）组。本研究的主要结局指标为镇痛药用量，次要结局指标为两组间的数字评分量表（NRS）。
两组在人口统计学、术前临床评估或手术特征方面无显著差异（P＞0.05）。TEA组的置管时间显著短于ESPB组（P＜0.05），而ESPB组的住院时间显著短于TEA组（P＜0.05）。在口服吗啡等效量比较方面，术后第1天和第2天TEA组所需剂量低于ESPB组（P＜0.05），术后第3天和第4天两组间无统计学差异（P＞0.05）。术后第1天TEA组中静息NRS≥7分和动态NRS≥7分的患者数量低于ESPB组（P＜0.05）。其他时间点两组间无显著差异（P＞0.05）。
超声引导下ESPB用于小儿漏斗胸Nuss手术，可为手术提供良好的镇痛效果，缩短患者术后康复及住院时间。它是TEA的一种安全有效的替代方法。
