区域阻滞与接受电视辅助胸腔镜手术患者术中阿片类药物消耗的关联：一项单中心回顾性研究。

The association of regional block with intraoperative opioid consumption in patients undergoing video-assisted thoracoscopic surgery: a single-center, retrospective study.

机构信息

Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.

Department of Medical Statistics, Medieco Group Co., Ltd, Beijing, China.

出版信息

J Cardiothorac Surg. 2024 Mar 13;19(1):124. doi: 10.1186/s13019-024-02611-3.

DOI:10.1186/s13019-024-02611-3

PMID:38481337

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10936020/

Abstract

BACKGROUND

Regional block, such as thoracic epidural analgesia (TEA), thoracic paravertebral block (TPVB), or serratus anterior plane block (SAPB) has been recommended to reduce postoperative opioid use in recent guidelines, but the optimal options for intraoperative opioid minimization remain unclear. The aim of this study was to evaluate the intraoperative opioids-sparing effects of three regional blocks (TEA, TPVB, and SAPB) in patients undergoing video-assisted thoracoscopic surgery (VATs).

METHODS

This was a retrospective study of the adults undergoing VATs at a tertiary medical center between January 2020 and February 2022. According to the type of regional block used, patients were classified into 4 groups: GA group (general anesthesia without any regional block), TEA group (general anesthesia combined with TEA), TPVB group (general anesthesia combined with TPVB), and SAPB group (general anesthesia combined with SAPB). Cases were matched with a 1:1:1:1 ratio for analysis by age, sex, ASA physical status, and operation duration. The primary outcome was the total intraoperative opioid consumption standardized to Oral Morphine Equivalents (OME). Multivariable linear regression was used to estimate the association of the three regional blocks with the OME.

RESULTS

A total of 2159 cases met the eligibility criteria. After matching, 168 cases (42 in each group) were included in analysis. Compared with GA without any reginal block, the use of TEA, TPVB, and SAPB reduced the median of intraoperative OME by 78.45 mg (95% confidence interval [CI], -141.34 to -15.56; P = 0.014), 94.92 mg (95% CI, -154.48 to -35.36; P = 0.020), and 11.47 mg (95% CI, -72.07 to 49.14; P = 0.711), respectively.

CONCLUSIONS

The use of TEA or TPVB was associated with an intraoperative opioid-sparing effect in adults undergoing VATs, whereas the intraoperative opioid-sparing effect of SAPB was not yet clear.

摘要

背景

在最近的指南中，区域阻滞（如胸硬膜外镇痛（TEA）、胸椎旁神经阻滞（TPVB）或前锯肌平面阻滞（SAPB））被推荐用于减少术后阿片类药物的使用，但最佳的术中阿片类药物最小化方案仍不清楚。本研究旨在评估三种区域阻滞（TEA、TPVB 和 SAPB）在接受电视辅助胸腔镜手术（VATS）的患者中的术中阿片类药物节省效果。

方法

这是一项回顾性研究，纳入了 2020 年 1 月至 2022 年 2 月期间在一家三级医学中心接受 VATS 的成年人。根据使用的区域阻滞类型，患者分为 4 组：GA 组（无任何区域阻滞的全身麻醉）、TEA 组（全身麻醉联合 TEA）、TPVB 组（全身麻醉联合 TPVB）和 SAPB 组（全身麻醉联合 SAPB）。通过年龄、性别、ASA 身体状况和手术时间进行 1:1:1:1 匹配分析。主要结局为标准化为口服吗啡当量（OME）的术中总阿片类药物消耗。多变量线性回归用于估计三种区域阻滞与 OME 的关联。

结果

共有 2159 例符合入选标准。匹配后，168 例（每组 42 例）纳入分析。与 GA 无任何区域阻滞相比，使用 TEA、TPVB 和 SAPB 分别减少了术中 OME 的中位数 78.45mg（95%CI，-141.34 至 -15.56；P=0.014）、94.92mg（95%CI，-154.48 至 -35.36；P=0.020）和 11.47mg（95%CI，-72.07 至 49.14；P=0.711）。