But Michał, Wernicki Krzysztof, Zieliński Jacek, Szczecińska Weronika
Pain Treatment Clinic, Polyclinic in Koszalin, 75-720 Koszalin, Poland.
The Department of Anesthesiology and Intensive Care, Provincial Hospital in Koszalin, 75-581 Koszalin, Poland.
J Clin Med. 2024 Aug 16;13(16):4836. doi: 10.3390/jcm13164836.
The paravertebral block (PVB) is a well-studied, effective method of analgesia for breast surgery. Alternative techniques involving the blockage of intercostal nerve branches are the serratus anterior plane block (SAPB) and the erector spinae plane block (ESPB). However, no studies comparing both fascial blocks to PVB in breast surgery have been published to date. We evaluated the effectiveness of ESPB and SAPB vs. PVB, expressed as the requirement for intraoperative fentanyl, pain intensity at rest and during coughing, and morphine consumption on the first postoperative day. Additional aims were to perform an evaluation of the safety of the block types used. : A total of 77 women and 1 man with stage I and II clinical breast cancer, aged 18-85 years, were randomized into one of three study groups: SAPB, PVB, and ESPB. There were no statistically significant differences in fentanyl consumption during surgery with respect to the type of block used ( = 0.4246). Morphine consumption in the postoperative period was highest in the ESPB group, averaging 9.4 mg. There was a statistically significant difference in pain intensity from 4 pm on the day of surgery to 8 am the following morning. No complications related to the blocks were observed on the first postoperative day. Both the serratus anterior plane block and the erector spinae plane block were as effective as the paravertebral block in achieving intraoperative analgesia. The serratus anterior plane block was equally as effective as the paravertebral block in achieving postoperative analgesia. The erector spinae plane block was significantly less effective in achieving postoperative analgesia than both the paravertebral block and serratus anterior plane block.
椎旁阻滞（PVB）是一种经过充分研究的、用于乳腺手术的有效镇痛方法。涉及肋间神经分支阻滞的替代技术包括前锯肌平面阻滞（SAPB）和竖脊肌平面阻滞（ESPB）。然而，迄今为止，尚无关于乳腺手术中比较这两种筋膜阻滞与PVB的研究发表。我们评估了ESPB和SAPB与PVB的有效性，指标为术中芬太尼需求、静息和咳嗽时的疼痛强度以及术后第一天的吗啡消耗量。其他目的是对所用阻滞类型的安全性进行评估。共有77名女性和1名男性，年龄在18 - 85岁之间，患有I期和II期临床乳腺癌，被随机分为三个研究组之一：SAPB组、PVB组和ESPB组。在手术期间，所用阻滞类型对芬太尼消耗量没有统计学上的显著差异（P = 0.4246）。ESPB组术后吗啡消耗量最高，平均为9.4毫克。从手术当天下午4点到次日上午8点，疼痛强度存在统计学上的显著差异。术后第一天未观察到与阻滞相关的并发症。前锯肌平面阻滞和竖脊肌平面阻滞在实现术中镇痛方面与椎旁阻滞同样有效。前锯肌平面阻滞在实现术后镇痛方面与椎旁阻滞同样有效。竖脊肌平面阻滞在实现术后镇痛方面明显不如椎旁阻滞和前锯肌平面阻滞有效。
