在接受半椎板切除术的犬中，腰椎竖脊肌平面阻滞的围手术期镇痛效果：一项随机、盲法临床试验。
Perioperative analgesic efficacy of lumbar erector spinae plane block in dogs undergoing hemilaminectomy: a randomized blinded clinical trial.
机构信息
Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium.
Department of Veterinary Sciences, Veterinary Teaching Hospital "Mario Modenato", University of Pisa, Pisa, Italy.
出版信息
Vet Anaesth Analg. 2024 Mar-Apr;51(2):181-189. doi: 10.1016/j.vaa.2023.12.001. Epub 2023 Dec 11.
OBJECTIVE
To evaluate the perioperative analgesic effect of the unilateral lumbar erector spinae plane block (ESPB) in dogs undergoing hemilaminectomy.
STUDY DESIGN
Randomized, blinded clinical study.
ANIMALS
A total of 30 client-owned dogs undergoing thoracolumbar or lumbar hemilaminectomy for intervertebral disc extrusion (IVDE).
METHODS
Dogs were randomly assigned to receive a unilateral ESPB, performed either with 0.4 mL kg ropivacaine 0.5% [group ROPI (n = 15)] or with saline solution [CNT group (n = 15)]. Dogs were premedicated intravenously (IV) with acepromazine 5 μg kg and methadone 0.2 mg kg, general anaesthesia was induced by administering IV midazolam 0.2 mg kg and propofol to effect and maintained with isoflurane. Fentanyl was administered as rescue analgesia. Bradycardia [heart rate (HR) < 60 beats minute] with hypotension was treated with atropine IV. The Short-Form of the Glasgow Composite Pain Scale was used pre- and postoperatively at 1, 2, 4, 8, 12, 16, 20 and 24 hours after extubation, and methadone 0.2 mg kg was administered IV when pain score was ≥ 5/20. HR and end-tidal concentration of isoflurane (Fe'Iso) were compared between groups with anova combined with a Dunnet's post hoc test. Time to the first rescue methadone and total dose of fentanyl (FEN, μg kg hour) and methadone (MET, mg kg) in the first 24 postoperative hours were compared using unpaired Student's t test. Postoperative pain scores were compared with the Mann-Whitney test and atropine administration with a Fisher's exact test; p < 0.05.
RESULTS
HR, Fe'Iso, FEN, MET and atropine administration were significantly lower in group ROPI compared to CNT. Postoperative analgesic effect was significantly longer, and pain scores were significantly lower in group ROPI for all time points.
CONCLUSIONS AND CLINICAL RELEVANCE
Unilateral ESPB with ropivacaine reduced perioperative opioid consumption and the occurrence of bradycardia in dogs undergoing hemilaminectomy.
目的
评估单侧竖脊肌平面阻滞（ESPB）在接受半椎板切除术的犬中的围手术期镇痛效果。
研究设计
随机、盲法临床研究。
动物
共 30 只接受胸腰椎或腰椎半椎板切除术治疗椎间盘突出症（IVDE）的患犬。
方法
犬随机分为接受单侧 ESPB 组，分别用 0.4 mL kg 罗哌卡因 0.5%[ROPI 组（n=15）]或生理盐水溶液[对照组（n=15）]进行治疗。犬静脉（IV）预注安定 5 μg kg 和 美沙酮 0.2 mg kg，静脉注射咪达唑仑 0.2 mg kg 诱导全身麻醉，并以异氟醚维持麻醉。芬太尼作为解救性镇痛药物。心动过缓[心率（HR）<60 次/分钟]伴低血压用 IV 阿托品治疗。在拔管后即刻和术后 1、2、4、8、12、16、20 和 24 小时使用简短版格拉斯哥复合疼痛量表（SF-CPS）进行术前和术后评估，当疼痛评分≥5/20 时静脉注射美沙酮 0.2 mg kg。采用方差分析结合 Dunnett 事后检验比较两组间 HR 和呼气末异氟醚浓度（Fe'Iso）。采用配对 Student's t 检验比较术后 24 小时内首次解救性美沙酮的时间、芬太尼（FEN，μg kg hour）和吗啡（MET，mg kg）的总剂量。采用 Mann-Whitney 检验比较术后疼痛评分，Fisher 确切概率法比较阿托品使用情况；p<0.05。
结果
与 CNT 组相比，ROPI 组的 HR、Fe'Iso、FEN、MET 和阿托品使用率显著降低。ROPI 组的术后镇痛效果显著延长，所有时间点的疼痛评分均显著降低。
结论和临床相关性
罗哌卡因单侧 ESPB 可减少接受半椎板切除术的犬的围手术期阿片类药物消耗和心动过缓的发生。
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