Gavrilovska-Brzanov Aleksandra, Jovanovski-Srceva Marija, Brzanov Nikola, Petrusheva Aleksandra Panovska, Ivanovski Ognen, Trifunovski Aleksandar, Stankov Viktor, Ambardjieva Martina, Burmuzoska Marjana, Nastasovic Tijana, Kuzamanovska Biljana
1University Clinic for Traumatology, Orthopedic Disease, Anesthesiology, Reanimation and Intensive Care Medicine and Emergency Department, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, RN Macedonia.
2University Clinic for Urology, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, RN Macedonia.
Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2025 Jul 5;46(2):23-32. doi: 10.2478/prilozi-2025-0010. Print 2025 Jun 1.
: The erector spinae plane block (ESPB) is a regional anesthesia technique that provides somatic and visceral analgesia by targeting the dorsal and ventral rami of the spinal nerves. It is performed under ultrasound guidance. ESPB is particularly beneficial in urological surgeries, which often require multimodal analgesia due to complex pain management needs and patient comorbidities. However, its efficacy in urological procedures remains insufficiently studied. Therefore, our aim was to assess the effectiveness and advantages of ESPB in urological procedures. : This prospective observational study was conducted at a tertiary referral hospital. The study included all consecutive patients scheduled for urological surgery, classical approach, or laparoscopic surgery under general anesthesia. Patients were ASA I-III, aged ≥18 years. Exclusion criteria included coagulopathy, infection at the injection site, allergy to local anesthetics, and chronic opioid therapy. ESPB was performed under ultrasound guidance, and a 20G echogenic needle was used to administer 20-30 mL of 0.5% bupivacaine at the Th8-L2 vertebrae level, depending on surgical requirements. The primary outcome, postoperative pain, was measured using a visual analog scale at 2, 6, 12, and 24 hours. The incidence of postoperative nausea and vomiting (PONV), the total amount of opioids consumed in a 24-hour period, and intraoperative hemodynamic stability were the secondary outcomes. IV fentanyl and paracetamol were used for postoperative analgesia, and metoclopramide was used to control nausea. : Fifty patients (42 males, 8 females, mean age 66±9.8 years) were analyzed. The majority were ASA II (44%) and ASA III (50%). Open surgeries were performed on 21 patients, while 19 underwent laparoscopic procedures. Primary Outcome: Pain scores (VAS) at 6h, 12h, and 24h were significantly lower in laparoscopic groups compared to open surgeries (p<0.05). Secondary Outcomes: Only three patients (6%) from the open classical approach surgery required rescue opioids. PONV occurred in two patients (4%): one from the open and the other from the laparoscopic approach surgery. Intraoperative hemodynamics remained stable, with no significant fluctuations in MAP or HR. : ESPB provided effective analgesia, reduced opioid consumption, and maintained hemodynamic stability in urological surgeries, supporting its role in multimodal pain management strategies.
竖脊肌平面阻滞（ESPB）是一种区域麻醉技术，通过靶向脊神经的背支和腹支来提供躯体和内脏镇痛。它在超声引导下进行。ESPB在泌尿外科手术中特别有益，由于复杂的疼痛管理需求和患者合并症，泌尿外科手术通常需要多模式镇痛。然而，其在泌尿外科手术中的疗效仍研究不足。因此，我们的目的是评估ESPB在泌尿外科手术中的有效性和优势。
这项前瞻性观察性研究在一家三级转诊医院进行。该研究纳入了所有计划在全身麻醉下进行泌尿外科手术、传统手术或腹腔镜手术的连续患者。患者为ASA I - III级，年龄≥18岁。排除标准包括凝血功能障碍、注射部位感染、对局部麻醉药过敏和慢性阿片类药物治疗。ESPB在超声引导下进行，根据手术需要，使用20G超声针在胸8 - 腰2椎体水平注射20 - 30 mL 0.5%布比卡因。主要结局指标术后疼痛，在术后2、6、12和24小时使用视觉模拟量表进行测量。术后恶心呕吐（PONV）的发生率、24小时内阿片类药物的总消耗量以及术中血流动力学稳定性为次要结局指标。静脉注射芬太尼和对乙酰氨基酚用于术后镇痛，甲氧氯普胺用于控制恶心。
分析了50例患者（42例男性，8例女性，平均年龄66±9.8岁）。大多数为ASA II级（44%）和ASA III级（(50%）。21例患者进行了开放手术，19例接受了腹腔镜手术。主要结局：与开放手术相比，腹腔镜组在术后6小时、12小时和24小时的疼痛评分（VAS）显著更低（p<0.05）。次要结局：开放传统手术组只有3例患者（6%）需要追加阿片类药物。2例患者（4%）发生PONV：1例来自开放手术组，另1例来自腹腔镜手术组。术中血流动力学保持稳定，平均动脉压（MAP）或心率（HR）无显著波动。
ESPB在泌尿外科手术中提供了有效的镇痛，减少了阿片类药物的消耗，并维持了血流动力学稳定，支持其在多模式疼痛管理策略中的作用。
