Altun Gozde, Esin Ayla, Ozsahin Yasemin, Arslan Sukru, Erkalp Kerem, Salihoglu Ziya
Department of Anesthesiology and Reanimation, Istanbul University-Cerrahpasa, Institute of Cardiology, Cerrahpaşa Mah, Org. Abdurrahman Nafiz Gürman Cd. Bina no.24, 34098, Haseki Caddesi No:32, Fatih, İstanbul, 34096, Turkey.
Department of Cardiology, Istanbul University-Cerrahpasa, Institute of Cardiology, Cerrahpaşa Mah, Org. Abdurrahman Nafiz Gürman Cd. Bina no.24, 34098, Haseki Caddesi No:32, Fatih, İstanbul, 34096, Turkey.
BMC Anesthesiol. 2025 Jul 1;25(1):328. doi: 10.1186/s12871-025-03206-8.
Rhomboid intercostal plane block (RIB) has been described in the last decade. In this study, we aimed to evaluate the outcomes of RIB in terms of perioperative analgesia and patient and physician satisfaction in patients undergoing CIED.
The randomized controlled trial was structured into two arms, each comprising 25 patients and allocation was performed using a sealed-envelope randomization technique. Local anaesthesia group-LAG received only local anaesthesia (LA) (prilocaine 2%) as the standard procedure. RIB group-RIBG received RIB in addition to the standard procedure. Demographic and clinical data about the patients and the procedures performed were recorded. The first and second rescue treatments in cases of pain during the procedure and the first and second rescue treatments during the postoperative follow-up were also recorded. Pain levels during the procedure, at the end of the procedure and 3, 6, 12, and 24 h after the procedure were determined according to the NRS-11(Numeric Rating Scale-11). Patient and physician satisfaction were recorded on a five-point Likert scale. The primary outcome of the study was the efficacy of RIB in patients undergoing CIED implantation, assessed by NRS-11 pain scores during the procedure and in the postoperative period. As secondary outcome, patient and physician satisfaction levels were evaluated during the procedure.
There was less need for additional local anaesthetic in the RIBG than in the LAG ( < 0.001). NRS-11 scores during implantation, at the end of the implantation procedure, and at the 3-, 6-, 12-, and 24-hour follow-ups were greater in the LAG ( < 0.001). The satisfaction levels of both doctors and patients were higher in the RIBG ( < 0.001).
RIB application in CIED implantations showed adequate analgesic efficacy in patients during the perioperative period and up to 24 h postoperatively. At the same time, it provided high procedural satisfaction for patients and physicians. RIB should be considered in the multimodal analgesia approach in the perioperative analgesia of this patient group. There is a need for collaboration between anaesthesiologists and cardiologists to establish protocols, including RIB, for perioperative pain management in patients who undergo CIED implantation.
This study was registered in the Clinical Trials (ID: NCT06449599, 27/05/2024).
菱形肋间平面阻滞（RIB）在过去十年中已有相关描述。在本研究中，我们旨在评估RIB在接受心脏植入电子设备（CIED）患者的围手术期镇痛、患者及医生满意度方面的效果。
随机对照试验分为两组，每组25例患者，采用密封信封随机化技术进行分配。局部麻醉组（LAG）仅接受作为标准操作的局部麻醉（LA）（2%丙胺卡因）。菱形肋间平面阻滞组（RIBG）除标准操作外还接受RIB。记录患者的人口统计学和临床数据以及所实施的操作。还记录了术中疼痛时的首次和第二次补救治疗以及术后随访期间的首次和第二次补救治疗。根据数字评定量表-11（NRS-11）确定术中、手术结束时以及术后3、6、12和24小时的疼痛程度。患者和医生的满意度采用五点李克特量表记录。本研究的主要结局是通过术中及术后NRS-11疼痛评分评估RIB在接受CIED植入患者中的疗效。作为次要结局，评估术中患者和医生的满意度水平。
RIBG组比LAG组对额外局部麻醉的需求更少（<0.001）。LAG组在植入过程中、植入手术结束时以及3、6、12和24小时随访时的NRS-11评分更高（<0.001）。RIBG组医生和患者的满意度更高（<0.001）。
在CIED植入术中应用RIB对患者围手术期及术后24小时显示出足够的镇痛效果。同时，它为患者和医生提供了较高的操作满意度。在该患者群体的围手术期镇痛多模式镇痛方法中应考虑RIB。麻醉医生和心脏病专家需要合作制定包括RIB在内的围手术期疼痛管理方案，用于接受CIED植入的患者。
本研究已在临床试验注册（ID：NCT06449599，2024年5月27日）。
