Datchinamourthy Thamizharasan, Bhoi Debesh, Chhabra Anjolie, Mohan Virender K, Kumar Kanil R, Ranganathan Poornima
Department of Anaesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India.
Indian J Anaesth. 2024 Mar;68(3):273-279. doi: 10.4103/ija.ija_922_23. Epub 2024 Feb 22.
Single-shot erector spinae plane block (ESPB) provides excellent analgesia in mastectomy in the immediate post-operative period but is not sufficient to maintain for prolonged duration. This study compares the efficacy of programmed intermittent bolus (PIB) versus continuous infusion (CI) techniques after ESPB by placing a catheter for mastectomy.
After ethical approval and patient consent, ESPB was performed at the T4 level in 50 patients with an initial bolus of 20 mL 0.375% ropivacaine and a catheter placed 30 min before surgery. In the postoperative period, they were randomised to Group I - intermittent bolus of 20 mL 0.2% ropivacaine every 4 h for 24 h and Group C - continuous infusion of 0.2% ropivacaine at 5 mL/h for 24 h. The primary outcome was the 24-h fentanyl consumption by patient-controlled analgesia device. Data was analysed using Stata 14.0.
Group I patients had reduced post-operative fentanyl consumption {mean [standard deviation (SD)]: 166 (139.17) µg vs 332 (247.96) µg, = 0.002} and lower median NRS scores (1 h: 3 vs 5), (2 h: 3 vs 5), (4 h: 3 vs 5), (6 h: 4 vs 5) with a higher mean (SD) Quality of Recovery-15 score {134.4 (8.53) vs 127 (12.89), = 0.020} compared to Group C, respectively. The 24-h dermatomal sensory coverage was more comprehensive in Group I compared to Group C.
The PIB technique after ESPB provides decreased postoperative opioid consumption, better post-operative analgesia and quality of recovery compared to the CI technique in patients undergoing mastectomy.
单次竖脊肌平面阻滞（ESPB）在乳房切除术后即刻可提供良好的镇痛效果，但不足以维持较长时间。本研究通过为乳房切除术放置导管，比较ESPB后程序化间歇性推注（PIB）与持续输注（CI）技术的疗效。
经伦理批准并获得患者同意后，对50例患者在T4水平进行ESPB，初始推注20 mL 0.375%罗哌卡因，并在手术前30分钟放置导管。术后，将患者随机分为I组——每4小时间歇性推注20 mL 0.2%罗哌卡因，共24小时；C组——以5 mL/h的速度持续输注0.2%罗哌卡因，共24小时。主要结局是患者自控镇痛装置24小时内的芬太尼消耗量。使用Stata 14.0对数据进行分析。
I组患者术后芬太尼消耗量减少{均值[标准差（SD）]：166（139.17）μg对332（247.96）μg，P = 0.002}，NRS评分中位数较低（1小时：3对5），（2小时：3对5），（4小时：3对5），（6小时：4对5），与C组相比，恢复质量-15评分的均值（SD）更高{134.4（8.53）对127（12.89），P = 0.020}。与C组相比，I组24小时的皮节感觉覆盖更全面。
在接受乳房切除术的患者中，ESPB后的PIB技术与CI技术相比，术后阿片类药物消耗量减少，术后镇痛效果更好，恢复质量更高。
