Ju Qiji, Li Ping, Zhang Long, Zhang Liangguang, Liu Guanyi, Yuan Liyong, Zhu Miao
Department of Anesthesiology, Ningbo No. 6 Hospital affiliated with Medical School of Ningbo University, No. 1059 Zhongshan East Road, Ningbo, 315040, Zhejiang, China.
Department of Anesthesiology, Ningbo Medical Center Lihuili Hospital, Ningbo, 315046, Zhejiang, China.
BMC Anesthesiol. 2025 Jul 1;25(1):301. doi: 10.1186/s12871-025-03181-0.
Patients with multiple rib fractures (MRFs) often experience severe postoperative pain. The parascapular sub-iliocostalis plane (PSIP) block holds promise as an effective method for analgesia, warranting further investigation and validation.
In this double-masked randomized trial, eligible MRF patients underwent surgery and were allocated to receive either preoperative PSIP block (intervention) or standard care (control). Postoperative outcomes including pain trajectories (serial VAS assessments), analgesic consumption, hemodynamic stability, recovery metrics (QoR-15), and adverse events were systematically evaluated. Statistical analyses adhered to intention-to-treat principles.
The AUC of VAS curves of Group PSIP was lower ( = 0.016). The VAS of Group PSIP were lower at 0.5 h, 2 h, 6 h, 12 h, and 24 h after the extubation ( < 0.001, 0.005, < 0.001, 0.020, 0.029). There was a decrease in VAS in Group PSIP after blocking ( < 0.001). Patients in Group PSIP required a lesser amount of analgesics within the initial twenty-four hours following surgery ( = 0.026). Group C had a significantly earlier use of analgesics ( < 0.001). At the time of skin incision, fracture reduction, suture and after extubation, Group PSIP had a lower MAP ( = 0.002, < 0.001, 0.003, 0.001) and AUC of MAP curves ( = 0.039). The Group PSIP exhibited lower Ricker scores in PACU, along with shorter observation times as well ( = 0.005, 0.046). The severity of PONV within 24 h post-surgery in the Group PSIP was also lower ( = 0.013). Moreover, at the 24 h post-surgery, the QoR-15 score was higher in Group PSIP ( = 0.025).
The PSIP block demonstrated efficacy in managing postoperative pain in patients with MRFs, mitigating intraoperative hemodynamic fluctuations and agitation during resuscitation, and enhancing short-term recovery outcomes following surgery.
多发性肋骨骨折（MRF）患者术后常经历严重疼痛。肩胛下-髂肋肌平面（PSIP）阻滞有望成为一种有效的镇痛方法，值得进一步研究和验证。
在这项双盲随机试验中，符合条件的MRF患者接受手术，并被分配接受术前PSIP阻滞（干预组）或标准护理（对照组）。系统评估术后结果，包括疼痛轨迹（连续视觉模拟评分法评估）、镇痛药物消耗、血流动力学稳定性、恢复指标（QoR-15）和不良事件。统计分析遵循意向性分析原则。
PSIP组视觉模拟评分曲线的曲线下面积较低（P = 0.016）。拔管后0.5小时、2小时、6小时、12小时和24小时，PSIP组的视觉模拟评分较低（P < 0.001、0.005、< 0.001、0.020、0.029）。阻滞术后PSIP组视觉模拟评分降低（P < 0.001）。PSIP组患者术后最初24小时内所需的镇痛药物量较少（P = 0.026）。C组使用镇痛药物的时间明显更早（P < 0.001）。在皮肤切开、骨折复位、缝合时以及拔管后，PSIP组平均动脉压较低（P = 0.002、< 0.001、0.003、0.001），平均动脉压曲线的曲线下面积也较低（P = 0.039）。PSIP组在麻醉后恢复室的Ricker评分较低，观察时间也较短（P = 0.005、0.046）。PSIP组术后24小时内恶心呕吐的严重程度也较低（P = 0.013）。此外，术后24小时，PSIP组的QoR-15评分较高（P = 0.025）。
PSIP阻滞在管理MRF患者术后疼痛、减轻术中血流动力学波动和复苏期间的躁动以及改善术后短期恢复结果方面显示出疗效。
