Elghamry Mona R, Messbah Wail E, Abduallah Mohammad A, Elrahwan Shimaa M
Department of Anesthesia, Surgical ICU and Pain Medicine, Faculty of Medicine, Tanta University, Egypt.
J Anaesthesiol Clin Pharmacol. 2024 Oct-Dec;40(4):653-658. doi: 10.4103/joacp.joacp_226_23. Epub 2024 Jul 19.
Pilonidal sinus surgery (PSS) can be done with local anaesthetic infiltration, spinal anaesthesia, or general anaesthesia (GA). Erector spinae plane block (ESPB) is used for peri-operative analgesia. Erector spinae muscles extend to the sacral region, so it can provide post-operative analgesia in PSS. We evaluate the post-operative analgesic efficacy of ultrasound-guided sacral ESPB, a novel technique, in patients undergoing PSS under GA.
Seventy patients aged 20-60 years, ASA class I and II, and scheduled for PSS under GA were included. Patients were randomly assigned to group I (control group), who received GA only, and in group II (SESPB group), sacral ESPB was performed after induction of GA. The primary outcome was post-operative pain evaluated by visual analogue score (VAS) at arrival to the post-anaesthesia care unit (PACU), 1, 2, 4, 8, 12, and 24 hours post-operative. The secondary outcomes were time to first analgesic request post-operative, intra-operative fentanyl consumption, and complications.
There were significantly higher VAS scores in group I compared to group II at arrival to PACU, 1, 2, 8, and 24 hours post-operative ( = 0.017, <0.001, <0.001, <0.001, and 0.031, respectively), and no considerable changes between groups at 4 and 12 hours ( = 0.664 and 0.923, respectively). A significant decrease in intra-operative fentanyl consumption with prolonged duration to time of first analgesic request post-operative in group II compared to group I was observed ( < 0.001). No reported complications were observed.
Sacral ESPB could provide an effective post-operative analgesia for PSS with no reported complications.
藏毛窦手术（PSS）可采用局部麻醉浸润、脊髓麻醉或全身麻醉（GA）进行。竖脊肌平面阻滞（ESPB）用于围手术期镇痛。竖脊肌延伸至骶骨区域，因此它可以为藏毛窦手术提供术后镇痛。我们评估了超声引导下骶部ESPB（一种新技术）在接受全身麻醉的藏毛窦手术患者中的术后镇痛效果。
纳入70例年龄在20 - 60岁、ASA分级为I级和II级且计划在全身麻醉下进行藏毛窦手术的患者。患者被随机分为I组（对照组），仅接受全身麻醉；II组（骶部ESPB组），在全身麻醉诱导后进行骶部ESPB。主要结局是术后到达麻醉后恢复室（PACU）时、术后1、2、4、8、12和24小时通过视觉模拟评分（VAS）评估的术后疼痛。次要结局是术后首次要求镇痛的时间、术中芬太尼用量和并发症。
术后到达PACU时、术后1、2、8和24小时，I组的VAS评分显著高于II组（分别为P = 0.017、P < 0.001、P < 0.001、P < 0.001和P = 0.031），4小时和12小时两组间无显著变化（分别为P = 0.664和P = 0.923）。与I组相比，II组术中芬太尼用量显著减少，术后首次要求镇痛的时间延长（P < 0.001）。未观察到报告的并发症。
骶部ESPB可为藏毛窦手术提供有效的术后镇痛，且未观察到报告的并发症。
