Hou Pengfei, Liu Wanxin, Chen Rongman, Mi Haiqi, Jia Shuaiying, Lin Jingyan
Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, No. 1, South Maoyuan Road, Nanchong, Sichuan, 637000, China.
Perioper Med (Lond). 2024 Dec 3;13(1):116. doi: 10.1186/s13741-024-00475-8.
Patients experience significant postoperative pain after laparoscopic resection of colorectal cancer. Transversus abdominis plane block (TAPB) provides effective analgesia, and recent studies have also shown that erector spinae plane block (ESPB) can be used for postoperative analgesia in abdominal surgery. However, there is a lack of comparison between the two methods regarding recovery quality following laparoscopic colorectal surgery.
Sixty patients scheduled for laparoscopic radical resection of colorectal cancer were randomly assigned to receive either a ESPB with TAPB (n = 30). Both groups received a single injection of 20 mL of 0.25% ropivacaine bilaterally. The primary outcome was the quality of recovery (QoR) at 24 h postoperatively, using the quality of recovery-15 (QoR-15) scale. Secondary outcomes included the QoR at 48 h postoperatively, visual analogue scale (VAS) pain scores during the first 48 h postoperatively in both resting and active states, requirements for rescue analgesia, cumulative postoperative opioid consumption, patient satisfaction, incidence of postoperative nausea and vomiting (PONV), time to first flatus and ambulation, the Comprehensive Complication Index (CCI) score, and postoperative hospital stay.
At 24 h postoperatively, the QoR-15 score (mean ± standard deviation) was significantly higher in the ESPB group (109.2 ± 8.7) compared to the TAPB group (101 ± 10.1) (p = 0.001). Similarly, at 48 h postoperatively, the QoR-15 score remained higher in the ESPB group (118.5 ± 8.8) than in the TAPB group (113.8 ± 8.1) (p = 0.035). Patients in the ESPB group reported lower visual analog scale (VAS) pain scores during the first 24 h postoperatively (all p < 0.05) compared to those in the TAPB group. The sufentanil consumption median (interquartile range) in the ESPB group at 24 h postoperatively was lower (62, 61-65 μg) compared to the TAPB group (66, 63-70 μg) (p < 0.001). Hospital stay median was 7 (6-9) days for the ESPB group and 8 (7-10) days for the TAPB group (p = 0.037).
Patients who received ESPB showed better recovery quality, improved analgesic effects, and higher postoperative satisfaction compared to those who underwent preoperative TAPB.
https://www.chictr.org.cn (ChiCTR2400081157); date of registration: February 24, 2024. The first participant was enrolled on February 27, 2024.
患者在腹腔镜结直肠癌切除术后会经历显著的术后疼痛。腹横肌平面阻滞（TAPB）可提供有效的镇痛效果，并且最近的研究还表明，竖脊肌平面阻滞（ESPB）可用于腹部手术的术后镇痛。然而，关于腹腔镜结直肠癌手术后这两种方法在恢复质量方面缺乏比较。
60例计划行腹腔镜结直肠癌根治术的患者被随机分配接受ESPB联合TAPB（n = 30）。两组均双侧单次注射20 mL 0.25%罗哌卡因。主要结局是术后24小时的恢复质量（QoR），采用恢复质量-15（QoR-15）量表进行评估。次要结局包括术后48小时的QoR、术后48小时内静息和活动状态下的视觉模拟评分（VAS）疼痛评分、补救性镇痛的需求、术后阿片类药物累计消耗量、患者满意度、术后恶心呕吐（PONV）的发生率、首次排气和下床活动时间、综合并发症指数（CCI）评分以及术后住院时间。
术后24小时，ESPB组的QoR-15评分（均值±标准差）为109.2±8.7，显著高于TAPB组的101±10.1（p = 0.001）。同样，术后48小时，ESPB组的QoR-15评分（118.5±8.8）仍高于TAPB组的113.8±8.1（p = 0.035）。与TAPB组相比，ESPB组患者在术后最初24小时内的视觉模拟评分（VAS）疼痛评分更低（所有p < 0.05）。术后24小时，ESPB组舒芬太尼消耗量中位数（四分位间距）为62（61 - 65）μg，低于TAPB组的66（63 - 70）μg（p < 0.001）。ESPB组的住院时间中位数为7（6 - 9）天，TAPB组为8（7 - 10）天（p = 0.037）。
与接受术前TAPB的患者相比，接受ESPB的患者显示出更好的恢复质量、改善的镇痛效果和更高的术后满意度。
https://www.chictr.org.cn（ChiCTR2400081157）；注册日期：2024年2月24日。第一名参与者于2024年2月27日入组。
