椎管内麻醉剖宫产术后应用竖脊肌平面阻滞与腹横肌平面阻滞的镇痛效果比较：一项随机对照试验。

Comparison of erector spinae plane and transversus abdominis plane block for postoperative analgesia after caesarean delivery under spinal anaesthesia: A randomised controlled trial.

机构信息

Department of Anaesthesiology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Anaesthesiology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.

Department of Anaesthesiology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Anaesthesiology, Rahima Moosa Mother and Child Hospital, Johannesburg, South Africa.

出版信息

Int J Obstet Anesth. 2024 Nov;60:104259. doi: 10.1016/j.ijoa.2024.104259. Epub 2024 Aug 30.

DOI:10.1016/j.ijoa.2024.104259

PMID:39307664

Abstract

BACKGROUND

Truncal blocks contribute to multimodal analgesia that enhances early recovery after caesarean delivery. The transversus abdominis plane (TAP) block is an established technique that offers somatic abdominal wall analgesia. The erector spinae plane (ESP) block is a fascial plane technique that may offer additional visceral analgesic effects. This study hypothesized that ESP block would offer superior analgesic efficacy to TAP block in women undergoing caesarean delivery under spinal anaesthesia.

METHODS

Sixty-six ASA physical status grade 1-3 (≥18 years) patients undergoing elective caesarean delivery under spinal anaesthesia were randomly allocated to receive either bilateral ultrasound-guided TAP (N = 33) or ESP blocks at the T9 vertebral level (N = 35). The primary outcome measure was 24-hour cumulative morphine consumption. The secondary outcomes included time to first analgesic request, duration of block placement, numeric rating scale (NRS) pain scores at rest and movement, effect of pain on activities of daily living (ADLs) and care for the infant, patient analgesic satisfaction, frequency and severity of opioid-related side effects.

RESULTS

There was no statistically significant difference in mean (95% CI) 24-hour cumulative morphine consumption between groups: 32.0 (27.0 to 37.0) mg with TAP versus 27.0 (19.9 to 34.0) mg with ESP (p = 0.16). The mean (SD) duration of block placement was longer for ESP than for TAP blocks (10.7 (2.2) minutes versus 9.0 (2.5) minutes; p = 0.004). There were no significant differences in the other secondary outcomes.

CONCLUSION

This study found similar postoperative opioid use and analgesic efficacy between ESP and TAP block after caesarean delivery performed under spinal anaesthesia.

TRIAL REGISTRATION

South African National Clinical Trial Registry (DOH-27-102022-5278): https://sanctr.samrc.ac.za/TrialDisplay.aspx?TrialID=8100, Pan African Clinical Trials Registry (PACTR202301645957324): https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=24267.

摘要

背景

躯干阻滞有助于多模式镇痛，可促进剖宫产术后的早期恢复。腹横肌平面（TAP）阻滞是一种已确立的技术，可提供躯体腹壁镇痛。竖脊肌平面（ESP）阻滞是一种筋膜平面技术，可能提供额外的内脏镇痛效果。本研究假设 ESP 阻滞在接受脊髓麻醉下剖宫产的患者中比 TAP 阻滞提供更好的镇痛效果。

方法

66 名 ASA 身体状况分级 1-3 级（≥18 岁）接受脊髓麻醉下择期剖宫产的患者被随机分配接受双侧超声引导 TAP（N=33）或 T9 椎骨水平的 ESP 阻滞（N=35）。主要观察指标为 24 小时累积吗啡消耗量。次要观察指标包括首次镇痛请求时间、阻滞放置时间、休息和运动时的数字评分量表（NRS）疼痛评分、疼痛对日常生活活动（ADL）和婴儿护理的影响、患者镇痛满意度、阿片类药物相关副作用的频率和严重程度。

结果

两组间 24 小时累积吗啡消耗量的均值（95%CI）无统计学差异：TAP 组 32.0（27.0 至 37.0）mg，ESP 组 27.0（19.9 至 34.0）mg（p=0.16）。ESP 阻滞的平均（SD）阻滞放置时间长于 TAP 阻滞（10.7（2.2）分钟对 9.0（2.5）分钟；p=0.004）。其他次要观察指标无显著差异。