Department of Anesthesiology, Peking University People's Hospital, Beijing, China.
Department of Anesthesiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China.
Can J Anaesth. 2024 Jun;71(6):784-792. doi: 10.1007/s12630-023-02637-6. Epub 2023 Nov 21.
Minimally invasive direct coronary artery bypass (MIDCAB) surgery is associated with significant postoperative pain. We aimed to investigate the efficacy of ultrasound-guided erector spinae plane block (ESPB) for analgesia after MIDCAB.
We conducted randomized controlled trial in 60 patients undergoing MIDCAB who received either a single-shot ESPB with 30 mL of ropivacaine 0.5% (ESPB group, n = 30) or normal saline 0.9% (control group, n = 30). The primary outcome was numerical rating scale (NRS) pain scores at rest within 48 hr postoperatively. The secondary outcomes included postoperative NRS pain scores on deep inspiration within 48 hr, hydromorphone consumption, and quality of recovery-15 (QoR-15) score at 24 and 48 hr.
Compared with the control group, the ESPB group had lower NRS pain scores at rest at 6 hr (estimated mean difference, -2.1; 99% confidence interval [CI], -2.7 to -1.5; P < 0.001), 12 hr (-1.9; 99% CI, -2.6 to -1.2; P < 0.001), and 18 hr (-1.2; 99% CI, -1.8 to -0.6; P < 0.001) after surgery. The ESPB group also showed lower pain scores on deep inspiration at 6 hr (-2.9; 99% CI, -3.6 to -2.1; P < 0.001), 12 hr (-2.3; 99% CI, -3.1 to -1.5; P < 0.001), and 18 hr (-1.0; 99% CI, -1.8 to -0.2; P = 0.01) postoperatively. Patients in the ESPB group had lower total intraoperative fentanyl use, lower 24-hr hydromorphone consumption, a shorter time to extubation, and a shorter time to intensive care unit (ICU) discharge.
Erector spinae plane block provided early effective postoperative analgesia and reduced opioid consumption, time to extubation, and ICU discharge in patients undergoing MIDCAB.
www.chictr.org.cn (ChiCTR2100052810); registered 5 November 2021.
微创直接冠状动脉旁路移植术（MIDCAB）术后疼痛明显。我们旨在研究超声引导竖脊肌平面阻滞（ESPB）在 MIDCAB 术后镇痛中的效果。
我们对 60 例行 MIDCAB 的患者进行了随机对照试验，这些患者接受了单次 ESPB 注射 30ml 0.5%罗哌卡因（ESPB 组，n=30）或 0.9%生理盐水（对照组，n=30）。主要结局是术后 48 小时内静息时的数字评分量表（NRS）疼痛评分。次要结局包括术后 48 小时内深呼吸时的 NRS 疼痛评分、氢吗啡酮消耗量和术后 24 小时和 48 小时的恢复质量-15（QoR-15）评分。
与对照组相比，ESPB 组术后 6 小时（估计平均差值，-2.1；99%置信区间[CI]，-2.7 至-1.5；P<0.001）、12 小时（-1.9；99%CI，-2.6 至-1.2；P<0.001）和 18 小时（-1.2；99%CI，-1.8 至-0.6；P<0.001）的 NRS 静息疼痛评分较低。ESPB 组在术后 6 小时（-2.9；99%CI，-3.6 至-2.1；P<0.001）、12 小时（-2.3；99%CI，-3.1 至-1.5；P<0.001）和 18 小时（-1.0；99%CI，-1.8 至-0.2；P=0.01）的深呼吸时疼痛评分也较低。ESPB 组术中芬太尼总用量较低，24 小时氢吗啡酮消耗量较低，拔管时间较短，入住 ICU 时间较短。
在接受 MIDCAB 的患者中，竖脊肌平面阻滞可提供早期有效的术后镇痛，并减少阿片类药物的使用、拔管时间和 ICU 出院时间。
www.chictr.org.cn（ChiCTR2100052810）；注册日期：2021 年 11 月 5 日。
