Ankara Bilkent City Hospital, Anesthesiology and Reanimation Clinic, University of Health Sciences, Ankara, Turkey.
Ministry of Health Ankara City Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey.
BMC Anesthesiol. 2024 Aug 5;24(1):274. doi: 10.1186/s12871-024-02659-7.
Severe pain occurs after cardiac surgery in the sternum and chest tubes sites. Although analgesia targeting the sternum is often prioritized, the analgesia of the drain site is sometimes overlooked. This study of patients undergoing coronary artery bypass grafting (CABG) aimed to provide optimized analgesia for both the sternum and the chest tubes area by combining parasternal block (PSB) and serratus anterior plane block (SAPB).
Ethics committee approval (E.Kurul-E2-24-6176, 07/02/2024) was received for the study. Then, the trial was registered on www.
gov ( https://clinicaltrials.gov/ ) under the identifier NCT05427955 on 17/03/2024. Twenty patients between the ages of 18-80, with ASA physical status classification II-III, undergoing coronary artery bypass grafting CABG with sternotomy, were included. While the patients were under general anesthesia, PSB was performed through the second and fourth intercostal spaces, and SAPB was performed over the sixth rib. The primary outcome was VAS (Visual Analog Scale) during the first 12 h after extubation. The secondary outcomes were intraoperative remifentanil consumption and block-related side effects.
The average age of the patients was 64 years. Five patients were female, and 15 were male. For the sternum area, only one patient had resting VAS scores of 4, while the VAS scores for resting for the other patients were below 4. For chest tubes area, only two patients had resting VAS scores of 4 or above, while the resting VAS scores for the other patients were below 4. The patients' intraoperative remifentanil consumption averaged 2.05 mg. No side effects related to analgesic protocol were observed in any of the patients.
In this preliminary study where PSB and SAPB were combined in patients undergoing CABG, effective analgesia was achieved for the sternum and chest tubes area.
心脏手术后胸骨和胸腔引流管部位会出现严重疼痛。尽管针对胸骨的镇痛通常是优先考虑的，但引流部位的镇痛有时会被忽视。本项针对冠状动脉旁路移植术（CABG）患者的研究旨在通过联合使用胸骨旁阻滞（PSB）和前锯肌平面阻滞（SAPB），为胸骨和胸腔引流管区域提供优化的镇痛。
本研究获得伦理委员会批准（E.Kurul-E2-24-6176，2024 年 02 月 07 日）。然后，该试验于 2024 年 03 月 17 日在 www.clinicaltrials.gov 上以标识符 NCT05427955 进行注册。纳入年龄在 18-80 岁之间、ASA 身体状况分级 II-III 级、行胸骨切开术的冠状动脉旁路移植术 CABG 患者 20 例。在全身麻醉下，通过第二和第四肋间隙进行 PSB，在第六肋上方进行 SAPB。主要结局为拔管后 12 小时内的 VAS（视觉模拟量表）评分。次要结局为术中瑞芬太尼的消耗量和与阻滞相关的副作用。
患者的平均年龄为 64 岁。5 例为女性，15 例为男性。对于胸骨区域，只有 1 例患者的静息 VAS 评分为 4 分，而其他患者的静息 VAS 评分均低于 4 分。对于胸腔引流管区域，只有 2 例患者的静息 VAS 评分为 4 分或以上，而其他患者的静息 VAS 评分均低于 4 分。患者的术中瑞芬太尼消耗量平均为 2.05 毫克。在任何患者中均未观察到与镇痛方案相关的副作用。
在本项初步研究中，我们在接受 CABG 的患者中联合使用 PSB 和 SAPB，实现了胸骨和胸腔引流管区域的有效镇痛。
Zotero 插件