Mamoun Mohamed A, Alrefaey Alrefaey K, Abo-Zeid Maha Ahmed
Department of Anaesthesia and Surgical Intensive Care, Mansoura University, Mansoura, Egypt.
Turk J Anaesthesiol Reanim. 2023 Oct 24;51(5):402-407. doi: 10.4274/TJAR.2023.231260.
Acute pain management after open abdominal surgeries is an essential goal in perioperative management.. Recently, serratus-intercostal plane block (SIPB) was suggested as an analgesic technique for upper abdominal surgeries.
This prospective, randomized, controlled study included sixty adult patients scheduled for open upper abdominal surgeries. Patients were allocated into two equal groups: SIPB group (S group, n = 30) and control group (the C group, n = 30). In the S group, SIPB was performed in the midaxillary line at the eighth rib level followed by continuous infusion of local anaesthetic for the first postoperative day. In the C group, no block was done. The primary objective of the study was to control postoperative pain on the first postoperative day as assessed by the numerical rating scale (NRS). Secondary outcomes included perioperative hemodynamics, total postoperative analgesic consumption, number of analgesic requests, and incidence of postoperative nausea and vomiting.
The mean postoperative NRS reported in group S was statistically lower than that in group C (2.4±0.7, 3.9±0.31, < 0.001). The postoperative morphine consumption was lower in the S group than in the C group [(0 (0-4), 3 (1-4), respectively, < 0.001]. The incidence of PONV was significantly lower in the S group than in the C group (16.7% and 40%, < 0.045).
SIPB was associated with a better analgesic profile compared with the control group after upper abdominal surgeries. Further studies are recommended to determine block safety in special patient groups, including bariatric and laparoscopic surgeries.
开放性腹部手术后的急性疼痛管理是围手术期管理的一个重要目标。最近，有人提出锯齿肌-肋间平面阻滞（SIPB）作为上腹部手术的一种镇痛技术。
这项前瞻性、随机对照研究纳入了60例计划进行开放性上腹部手术的成年患者。患者被分为两组，每组30例：SIPB组（S组）和对照组（C组）。在S组中，于腋中线第8肋水平进行SIPB，然后在术后第一天持续输注局部麻醉药。C组不进行阻滞。本研究的主要目的是通过数字评分量表（NRS）评估术后第一天的术后疼痛控制情况。次要结局包括围手术期血流动力学、术后总镇痛药物消耗量、镇痛需求次数以及术后恶心呕吐的发生率。
S组报告的术后平均NRS在统计学上低于C组（分别为2.4±0.7、3.9±0.31，<0.001）。S组术后吗啡消耗量低于C组[分别为0（0 - 4）、3（1 - 4），<0.001]。S组术后恶心呕吐的发生率显著低于C组（分别为16.7%和40%，<0.045）。
与对照组相比，上腹部手术后SIPB具有更好的镇痛效果。建议进一步研究以确定特殊患者群体（包括肥胖症和腹腔镜手术患者）的阻滞安全性。
