Department of Anesthesiology, Show Chwan Memorial Hospital, Changhua, Taiwan, ROC.
Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
J Chin Med Assoc. 2024 May 1;87(5):550-557. doi: 10.1097/JCMA.0000000000001086. Epub 2024 Mar 19.
Effective postoperative pain management is vital in cardiac surgery to prevent opioid dependency and respiratory complications. Previous studies on the erector spinae plane (ESP) block have focused on single-shot applications or immediate postoperative outcomes. This study evaluates the efficacy of continuous ESP block vs conventional care in reducing opioid consumption and enhancing respiratory function recovery postcardiac surgery over 72 hours.
A retrospective study at a tertiary hospital (January 2021-July 2022) included 262 elective cardiac surgery patients. Fifty-three received a preoperative ESP block, matched 1:1 with a control group (n = 53). The ESP group received 0.5% ropivacaine intraoperatively and 0.16% ropivacaine every 4 hours postoperatively. Outcomes measured were cumulative oral morphine equivalent (OME) dose within 72 hours postextubation, daily maximum numerical rating scale (NRS) ≥3, incentive spirometry volume, and %baseline performance, stratified by surgery type (sternotomy or thoracotomy).
Significant OME reduction was observed in the ESP group (sternotomy: median decrease of 113 mg, 95% CI: 60-157.5 mg, p < 0.001; thoracotomy: 172.5 mg, 95% CI: 45-285 mg, p = 0.010). The ESP group also had a lower risk of daily maximum NRS ≥3 (adjusted OR sternotomy: 0.22, p < 0.001; thoracotomy: 0.07, p < 0.001), a higher incentive spirometry volumes (sternotomy: mean increase of 149 mL, p = 0.019; thoracotomy: 521 mL, p = 0.017), and enhanced spirometry %baseline (sternotomy: mean increase of 11.5%, p = 0.014; thoracotomy: 26.5%, p < 0.001).
Continuous ESP block was associated with a reduction of postoperative opioid requirements, lower instances of pain scores ≥3, and improve incentive spirometry performance following cardiac surgery. These benefits appear particularly prominent in thoracotomy patients. Further prospective studies with larger sample size are required to validate these findings.
有效的术后疼痛管理对于预防心脏手术后的阿片类药物依赖和呼吸并发症至关重要。先前关于竖脊肌平面（ESP）阻滞的研究主要集中在单次应用或即刻术后结果上。本研究评估了连续 ESP 阻滞与常规护理相比，在减少心脏手术后 72 小时内阿片类药物消耗和增强呼吸功能恢复方面的效果。
这是一项在一家三级医院进行的回顾性研究（2021 年 1 月至 2022 年 7 月），纳入了 262 例择期心脏手术患者。其中 53 例接受术前 ESP 阻滞，与对照组（n=53）按 1:1 匹配。ESP 组在术中给予 0.5%罗哌卡因，术后每 4 小时给予 0.16%罗哌卡因。测量的结果是拔管后 72 小时内累积口服吗啡等效剂量（OME）、每日最大数字评分量表（NRS）≥3、激励肺活量计容积和%基础性能，按手术类型（胸骨切开术或开胸术）进行分层。
ESP 组 OME 显著减少（胸骨切开术：中位数减少 113mg，95%置信区间：60-157.5mg，p<0.001；开胸术：172.5mg，95%置信区间：45-285mg，p=0.010）。ESP 组每日最大 NRS≥3 的风险也较低（调整后的 OR 胸骨切开术：0.22，p<0.001；开胸术：0.07，p<0.001），激励肺活量计容积更高（胸骨切开术：平均增加 149mL，p=0.019；开胸术：521mL，p=0.017），并改善了肺活量的基础百分比（胸骨切开术：平均增加 11.5%，p=0.014；开胸术：26.5%，p<0.001）。
连续 ESP 阻滞与心脏手术后阿片类药物需求减少、疼痛评分≥3 的发生率降低以及激励肺活量计性能改善相关。这些益处在开胸术患者中似乎更为明显。需要更大样本量的前瞻性研究来验证这些发现。
