Bhat Hilal Ahmad, Khan Talib, Puri Arun, Narula Jatin, Mir Altaf Hussain, Wani Shaqul Qamar, Ashraf Hakeem Zubair, Sidiq Suhail, Kabir Saima
Department of Anaesthesiology, Sher I Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, 190011, India.
Division of CardioVascular & Thoracic Anaesthesia and Cardiothoracic Surgical Intensive Care Unit, Sher I Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Jammu and Kashmir, 190011, India.
J Anesth Analg Crit Care. 2024 Mar 1;4(1):17. doi: 10.1186/s44158-024-00148-4.
The efficacy of the erector spinae plane (ESP) block in mitigating postoperative pain has been shown for a range of thoracic and abdominal procedures. However, there is a paucity of literature investigating its impact on postoperative analgesia as well as its influence on weaning and subsequent recovery in comparison to thoracic epidural analgesia (TEA) in median sternotomy-based approach for open-cardiac surgeries and hence the study.
Irrespective of gender or age, 74 adult patients scheduled to undergo open cardiac surgery were enrolled and randomly allocated into two groups: the Group TEA (thoracic epidural block) and the Group ESP (bilateral Erector Spinae Plane block). The following variables were analysed prospectively and compared among the groups with regard to pain control, as determined by the VAS Scale both at rest (VAS) and during spirometry (VAS), time to extubation, quantity and frequency of rescue analgesia delivered, day of first ambulation, length of stay in the intensive care unit (ICU), and any adverse cardiac events (ACE), respiratory events (ARE), or other events, if pertinent.
Clinical and demographic variables were similar in both groups. Both groups had overall good pain control, as determined by the VAS scale both at rest (VAS) and with spirometry (VAS) with Group ESP demonstrating superior pain regulation compared to Group TEA during the post-extubation period at 6, 9, and 12 h, respectively (P > 0.05). Although statistically insignificant, the postoperative mean rescue analgesic doses utilised in both groups were comparable, but there was a higher frequency requirement in Group TEA. The hemodynamic and respiratory profiles were comparable, except for a few arrhythmias in Group TEA. With comparable results, early recovery, fast-track extubation, and intensive care unit (ICU) stay were achieved.
The ESP block has been found to have optimal analgesic effects during open cardiac surgery, resulting in a decreased need for additional analgesic doses and eliminating the possibility of a coagulation emergency. Consequently, it presents itself as a safer alternative to the potentially invasive thoracic epidural analgesia (TEA).
竖脊肌平面（ESP）阻滞在减轻一系列胸腹部手术后疼痛方面的疗效已得到证实。然而，与基于胸骨正中切开术的心脏直视手术中胸段硬膜外镇痛（TEA）相比，关于其对术后镇痛的影响以及对脱机和后续恢复的影响的文献较少，因此开展了本研究。
纳入74例计划接受心脏直视手术的成年患者，不分性别和年龄，随机分为两组：TEA组（胸段硬膜外阻滞）和ESP组（双侧竖脊肌平面阻滞）。前瞻性分析以下变量，并在两组之间比较疼痛控制情况，疼痛控制情况通过静息时（VAS）和肺活量测定时（VAS）的视觉模拟评分量表（VAS）确定，还比较拔管时间、给予的补救镇痛的量和频率、首次下床活动的天数、重症监护病房（ICU）住院时间以及任何不良心脏事件（ACE）、呼吸事件（ARE）或其他相关事件。
两组的临床和人口统计学变量相似。根据静息时（VAS）和肺活量测定时（VAS）的VAS量表，两组的总体疼痛控制良好，ESP组在拔管后6、9和12小时的疼痛调节优于TEA组（P>0.05）。虽然无统计学意义，但两组术后使用的平均补救镇痛剂量相当，但TEA组的需求频率更高。除TEA组有少数心律失常外，血流动力学和呼吸情况相当。结果相当，实现了早期恢复、快速拔管和重症监护病房（ICU）住院。
已发现ESP阻滞在心脏直视手术期间具有最佳镇痛效果，减少了额外镇痛剂量的需求，并消除了凝血紧急情况的可能性。因此，它是潜在侵入性胸段硬膜外镇痛（TEA）的更安全替代方案。
