Jiang Fei, Wu Ailing, Liang Yan, Huang Hui, Tian Wei, Chen Bogang, Liu Di
Department of Anesthesiology, The First People's Hospital of Neijiang, Neijiang, Sichuan, People's Republic of China.
J Pain Res. 2023 Jul 14;16:2383-2392. doi: 10.2147/JPR.S406498. eCollection 2023.
Adequate postoperative analgesia is a key to earlier recovery from open surgery. This work investigated the pain control and quality of patient recovery after hepatectomy to evaluate the modified continuous serratus anterior plane block (called low SAPB) for postoperative analgesia.
This single-center, blinded, randomized, controlled study included 136 patients who underwent hepatectomy under general anesthesia. For postoperative analgesia, the patients in the SAPB group were given a continuous low SAPB at the 7th intercostal space in the right mid-axillary line, and the patients in the control group were given continuous intravenous opioid analgesia. The numeric pain rating scale (NPRS) was used for pain assessment. The postoperative assessment focused on the remedial drug consumption, the occurrence of adverse postoperative analgesic reactions, and the quality of patient recovery evaluated with the QoR-15 questionnaire.
Compared to the controls, the SAPB patients had significantly lower NPRS scores at 12 h and 24 h at rest and 6 h, 12 h, and 24 h in motion, and a longer time to first use of remedial analgesics at 24 h, and higher overall QoR-15 scores at 24 h [124 (121, 126) vs 121 (120, 124)] and 48 h [129 (126, 147) vs 126 (125, 128)], after surgery. There was no significant difference in the incidence of analgesia-related adverse reactions between the two groups.
The continuous low SAPB could achieve superior pain control, especially for motor pain, to intravenous opioid analgesia during the first 24 h post-surgery. Even with no significant difference in the incidence of postoperative adverse reactions, patients with continuous low SAPB appeared to have a higher quality of recovery in the first two days post-surgery than patients with continuous intravenous analgesia.
充分的术后镇痛是开腹手术后早期恢复的关键。本研究旨在探讨肝切除术后的疼痛控制及患者恢复质量，以评估改良的连续前锯肌平面阻滞（即低位前锯肌平面阻滞）用于术后镇痛的效果。
本单中心、双盲、随机对照研究纳入了136例在全身麻醉下接受肝切除术的患者。术后镇痛方面，前锯肌平面阻滞组患者在右腋中线第7肋间接受连续低位前锯肌平面阻滞，对照组患者接受连续静脉阿片类药物镇痛。采用数字疼痛评分量表（NPRS）进行疼痛评估。术后评估重点关注补救药物的消耗量、术后镇痛不良反应的发生情况，以及用QoR-15问卷评估的患者恢复质量。
与对照组相比，前锯肌平面阻滞组患者在术后12小时和24小时静息时以及6小时、12小时和24小时活动时的NPRS评分显著更低，在24小时首次使用补救镇痛药的时间更长，术后24小时[124（121，126）对121（120，124）]和48小时[129（126，147）对126（125，128）]的总体QoR-15评分更高。两组之间镇痛相关不良反应的发生率无显著差异。
连续低位前锯肌平面阻滞在术后24小时内可实现优于静脉阿片类药物镇痛的疼痛控制，尤其是对运动痛的控制。即使术后不良反应的发生率无显著差异，但与连续静脉镇痛的患者相比，接受连续低位前锯肌平面阻滞的患者在术后前两天的恢复质量似乎更高。
