Erdem Gokhan, Kavak Akelma Fatma, Nalbant Burak, Gokbulut Ozaslan Nihal
Department of Anesthesiology and Reanimation, Ministry of Health Ankara Bilkent City Hospital, Çankaya, Ankara, Turkey
Department of Anesthesiology and Reanimation, Ministry of Health Ankara Bilkent City Hospital, Çankaya, Ankara, Turkey.
Reg Anesth Pain Med. 2025 Jun 30. doi: 10.1136/rapm-2025-106756.
Postoperative nausea and vomiting (PONV) is the most frequent surgical complication after pain. We assessed the effect of the erector spinae plane (ESP) block on PONV incidence, nausea severity, pain levels, rescue antiemetic and analgesic requirements, intraoperative remifentanil use, and the correlation between pain and nausea severity in patients undergoing elective single-level lumbar disc herniation (LDH) surgery.
A prospective, randomized, double-blind study included 92 patients with American Society of Anesthesiologists I-II status who were scheduled for lumbar disc herniation surgery under general anesthesia. Patients were randomized into two groups: the ESP group (Group E) and the control group (Group C). The ESP group received bilateral ESP block with 20 mL of 0.25% bupivacaine per side (total 40 mL) alongside standard intraoperative analgesia, while the control group received a sham block. All patients received intravenous ondansetron for PONV prophylaxis. Postoperatively, standard analgesia was provided; patients with a Numerical Rating Scale (NRS) score ≥4 received intravenous dexketoprofen. We defined PONV as significant nausea (NRS≥4), vomiting, or the need for rescue medication. Patients with persistent nausea (>20 min), no improvement in nausea score, or multiple vomiting episodes received 4 mg intravenous ondansetron.
A total of 81 patients (Group E: 40, Group C: 41) were included in the final analysis. The overall PONV incidence at 0-24 hours was 10% in the ESP group and 34.1% in the control group (p<0.05). The ESP group exhibited a significantly lower incidence of nausea at 0-2, 2-4, and 4-12 hours postoperatively (p<0.05). Rescue antiemetic use was also lower in the ESP group (p<0.05). Intraoperative remifentanil requirements decreased in the ESP group (p<0.05). Pain intensity was significantly lower in the ESP group at 0-2, 2-4, and 4-12 hours (p<0.05), with reduced rescue analgesic use at 0-24 hours (p<0.05). Postoperative pain and nausea intensity showed a strong positive correlation at 0-2 hours (p<0.001), with moderate correlations at 2-4, 4-12 (p<0.001), and 12-24 hours (p=0.003).
ESP block reduced PONV incidence and severity while providing effective analgesia in LDH surgery. This technique may contribute to multimodal analgesia and PONV prophylaxis.
NCT06710457/https://www.
gov/ (November/26/2024).
术后恶心呕吐（PONV）是仅次于疼痛的最常见手术并发症。我们评估了竖脊肌平面（ESP）阻滞对择期单节段腰椎间盘突出症（LDH）手术患者PONV发生率、恶心严重程度、疼痛程度、补救性使用止吐药和镇痛药的需求、术中瑞芬太尼的使用以及疼痛与恶心严重程度之间的相关性。
一项前瞻性、随机、双盲研究纳入了92例美国麻醉医师协会I-II级的患者，这些患者计划在全身麻醉下进行腰椎间盘突出症手术。患者被随机分为两组：ESP组（E组）和对照组（C组）。ESP组在接受标准术中镇痛的同时，每侧接受20 mL 0.25%布比卡因的双侧ESP阻滞（共40 mL），而对照组接受假阻滞。所有患者均接受静脉注射昂丹司琼预防PONV。术后提供标准镇痛；数字评分量表（NRS）评分≥4的患者接受静脉注射右酮洛芬。我们将PONV定义为严重恶心（NRS≥4）、呕吐或需要使用补救药物。持续性恶心（>20分钟）、恶心评分无改善或多次呕吐发作的患者接受4 mg静脉注射昂丹司琼。
最终分析纳入了81例患者（E组：40例，C组：41例）。ESP组0-24小时的总体PONV发生率为10%，对照组为34.1%（p<0.05）。ESP组术后0-2、2-4和4-12小时恶心发生率显著较低（p<0.05）。ESP组补救性使用止吐药的情况也较少（p<0.05）。ESP组术中瑞芬太尼需求量减少（p<0.05）。ESP组在0-2、2-4和4-12小时疼痛强度显著较低（p<0.05），0-24小时补救性使用镇痛药减少（p<0.05）。术后0-2小时疼痛和恶心强度呈强正相关（p<0.001），2-4、4-12小时（p<0.001）和12-24小时（p=0.003）呈中度相关。
ESP阻滞在LDH手术中降低了PONV的发生率和严重程度，同时提供了有效的镇痛。该技术可能有助于多模式镇痛和PONV预防。
NCT06710457/https://www.CLINICALTRIALS.gov/（2024年11月26日）。
