Coppens Steve, Hoogma Danny Feike, Dewinter Geertrui, Neyrinck Arne, Van Loon Philippe, Stessel Björn, Hassanin Jalil, Vandenbrande Jeroen, Du Pont Bert, Jansen Yanina, Fieuws Steffen, Rex Steffen
Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium; Biomedical Sciences Group, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium.
Anesthesiology. 2025 Oct 1;143(4):1015-1025. doi: 10.1097/ALN.0000000000005625. Epub 2025 Jun 19.
Although intercostal nerve blocks are sometimes approached with caution due to concerns about potentially high local anesthetic uptake, they remain a valuable tool in specific clinical situations. On the other hand, the erector spinae plane block is currently often favored for its broader coverage and versatility. The hypothesis was that the intercostal nerve block, applied directly by surgeons under direct vision in patients undergoing uniportal video-assisted thoracoscopic surgery, might offer superior analgesia and fewer complications compared to the erector spinae plane block.
In this multicenter, double-blind, placebo-controlled randomized trial, 100 patients undergoing uniportal thoracoscopic surgery (wedge excision or lobectomy) within an enhanced recovery program received either a surgical intercostal nerve block under thoracoscopic guidance or an ultrasound-guided erector spinae plane block, followed by 30 ml ropivacaine 0.5% (n = 50) or saline (n = 50). The primary outcome measured was 12-h morphine consumption postextubation. Secondary outcomes included 24-h morphine use, pain severity, rescue analgesia need, postoperative complications, and length of stay. Plasma levels of local anesthetics were also assessed.
The intercostal nerve block group had significantly lower mean 12-h morphine consumption compared to the erector spinae plane block group (10.9 mg vs . 17.6 mg; P = 0.0015), as well as lower mean 24-h consumption (18.7 mg vs . 26.7 mg; P = 0.018). Intercostal blocks also led to lower pain scores in the first 2 h postoperatively and a reduced need for rescue analgesia (16% vs . 40%; P = 0.0033). No differences were found in patient satisfaction, complications, or length of stay. Notably, the erector spinae plane block group showed higher systemic absorption of local anesthetics.
For uniportal thoracoscopic surgery, intercostal nerve block significantly reduces morphine consumption and systemic anesthetic absorption compared to erector spinae plane block.
尽管由于担心局部麻醉药的潜在高摄取量，肋间神经阻滞有时会谨慎使用，但在特定临床情况下，它仍然是一种有价值的工具。另一方面，竖脊肌平面阻滞目前因其更广泛的覆盖范围和多功能性而经常受到青睐。假设是，在单孔电视辅助胸腔镜手术患者中，由外科医生在直视下直接进行的肋间神经阻滞与竖脊肌平面阻滞相比，可能提供更好的镇痛效果且并发症更少。
在这项多中心、双盲、安慰剂对照的随机试验中，100名在强化康复计划内接受单孔胸腔镜手术（楔形切除或肺叶切除）的患者接受了胸腔镜引导下的外科肋间神经阻滞或超声引导下的竖脊肌平面阻滞，随后分别注射30毫升0.5%的罗哌卡因（n = 50）或生理盐水（n = 50）。测量的主要结局是拔管后12小时的吗啡消耗量。次要结局包括24小时吗啡使用量、疼痛严重程度、急救镇痛需求、术后并发症和住院时间。还评估了局部麻醉药的血浆水平。
与竖脊肌平面阻滞组相比，肋间神经阻滞组的平均12小时吗啡消耗量显著更低（10.9毫克对17.6毫克；P = 0.0015），平均24小时消耗量也更低（18.7毫克对26.7毫克；P = 0.018）。肋间神经阻滞还导致术后前2小时疼痛评分更低，急救镇痛需求减少（16%对40%；P = 0.0033）。在患者满意度、并发症或住院时间方面未发现差异。值得注意的是，竖脊肌平面阻滞组显示局部麻醉药的全身吸收更高。
对于单孔胸腔镜手术，与竖脊肌平面阻滞相比，肋间神经阻滞显著降低吗啡消耗量和全身麻醉药吸收。
