Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Pain Physician. 2024 Sep;27(7):425-433.
Thoracic paravertebral block (TPVB) is frequently used to treat pain following a pediatric Nuss procedure but is associated with various undesirable risks. The erector spinae plane block (ESPB) also provides postoperative analgesia, which is purported to be easier to administer and has a favorable safety profile. However, it remains unknown whether ESPB provides analgesia comparable to the TPVB technique post pediatric Nuss procedure.
This study aimed to compare the analgesic effects of ultrasound-guided ESPB and TPVB in children undergoing the Nuss procedure.
A prospective, randomized, noninferiority trial.
A university hospital in the People's Republic of China.
A total of 68 children aged 4 to 18 scheduled for the Nuss procedure were enrolled in the study. They were randomly assigned to receive a single-injection ultrasound-guided bilateral T5-level ESPB or TPVB with 0.5 mL/kg of 0.25% ropivacaine post anesthesia induction. All patients received postprocedure multimodal analgesia. The primary outcomes were pain scores at rest and 24 hours postprocedure. The secondary outcomes included total rescue morphine milligram equivalents, emergence agitation, chronic postprocedure pain, and side effects.
The median difference in pain scores at rest 24 hours postprocedure was 0 (95% CI, 0 to 1), demonstrating the noninferiority of ESPB to TPVB. In addition, the difference in oral morphine milligram equivalents at 24 hours postprocedure was -4.9 (95% CI, -16.7 to 7.9) with the ESPB group consuming median (interquartile range) 37.7 mg (12-53.2) vs 36.9 mg (23.9-58.1) for the TPVB group. We concluded that the non-inferiority of ESPB with regard to opioid consumption as the 95% CI upper limit of 7.9, which was within the predefined margin of 10. We found no significant differences in pain scores at rest or during coughing, incidences of chronic postoperative pain, emergence agitation, or side effects.
We did not evaluate the effect of analgesic protocols on patient-centric outcomes, such as resuming functional status and emotional wellbeing. Also, the sample size is small to some extent.
Preoperative ESPB, when combined with multimodal analgesia, was noninferior in analgesic effect compared with TPVB in terms of pain scores and opioid consumption in pediatric patients undergoing the Nuss procedure.
胸椎旁神经阻滞（TPVB）常用于治疗小儿 Nuss 手术后的疼痛，但与各种不良风险相关。竖脊肌平面阻滞（ESPB）也可提供术后镇痛，据称其更容易实施，且具有良好的安全性。然而，ESPB 能否提供与 TPVB 技术相当的术后镇痛效果，尚不清楚。
本研究旨在比较超声引导下 ESPB 和 TPVB 在小儿 Nuss 手术中的镇痛效果。
前瞻性、随机、非劣效性试验。
中国某大学医院。
共纳入 68 例 4 至 18 岁拟行 Nuss 手术的患儿，随机接受单次超声引导下双侧 T5 水平 ESPB 或 TPVB，局麻药为 0.25%罗哌卡因 0.5 mL/kg。所有患者均接受术后多模式镇痛。主要结局为术后静息和 24 小时的疼痛评分。次要结局包括总解救吗啡毫克当量、苏醒期躁动、慢性术后疼痛和不良反应。
术后 24 小时静息时疼痛评分的中位数差值为 0（95%CI，0 至 1），表明 ESPB 与 TPVB 相比具有非劣效性。此外，术后 24 小时口服吗啡毫克当量的差值为-4.9（95%CI，-16.7 至 7.9），ESPB 组中位数（四分位距）为 37.7mg（12-53.2），TPVB 组为 36.9mg（23.9-58.1）。我们得出结论，ESPB 在阿片类药物消耗方面的非劣效性，其 95%CI 上限为 7.9，在预设的 10 界限内。我们发现两组在静息或咳嗽时的疼痛评分、慢性术后疼痛、苏醒期躁动或不良反应发生率方面无显著差异。
我们没有评估镇痛方案对以患者为中心的结局（如恢复功能状态和情绪健康）的影响。此外，样本量在一定程度上较小。
在小儿 Nuss 手术中，术前 ESPB 联合多模式镇痛在疼痛评分和阿片类药物消耗方面与 TPVB 相比具有非劣效性。
