Moharam Saad A, ElSharkawy Mohammed S, Almohasseb Mhmoud A, Hamama Khaled, Mahmoud Mohamed A, Abogabal Marwa A
Anesthesiology, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt.
Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Al-Azhar University, Assiut, Egypt.
Indian J Anaesth. 2025 Aug;69(8):809-815. doi: 10.4103/ija.ija_3_25. Epub 2025 Jul 10.
Regional techniques are preferred for controlling post-thoracotomy pain due to lower complication rates. This study aimed to compare the analgesic efficacy and safety of ultrasound-guided external oblique intercostal block (EOIB) with thoracic erector spinae plane block (ESPB) for post-thoracotomy pain.
This randomised, double-blind, non-inferior clinical study involved 60 cases scheduled for thoracic surgery. Cases were randomly allocated into two groups: ESPB and EOIB groups. Using 30 mL 0.25% bupivacaine at the level of the thoracic vertebrae 5, both blocks were performed after induction of general anaesthesia. The primary outcome was morphine consumption in the first 24 hours postoperatively. The secondary outcomes were time to first rescue analgesic request postoperatively, numerical rating scale (NRS) score during rest and with coughing, and occurrence of complications. The non-parametric Wilcoxon test was used for non-normally distributed variables, the Student's -test was used for normally distributed variables, and the Chi-square/Fisher's exact test was used for qualitative variables. The significance level was set at ≤ 0.05.
Patients who required intraoperative fentanyl, time of first request for analgesia, total morphine consumption, and pain score within the first 24 hours post-surgery were comparable between the two groups ( = 0.347, 0.085, and 0.354, respectively). Both groups exhibited comparable incidences of hypotension and bradycardia ( = 0.353 and > 0.99, respectively). Local anaesthetic systemic toxicity (LAST) and pneumothorax did not occur in any patient in either group.
The analgesic effect of EOIB was non-inferior to ESPB for post-thoracotomy pain, as evidenced by comparable total opioid consumption, time of first request for analgesia, and pain score in the first 24 hours post-surgery. Additionally, EOIB demonstrated the same level of safety as ESPB.
由于并发症发生率较低，区域技术更常用于控制开胸术后疼痛。本研究旨在比较超声引导下的腹外斜肌肋间阻滞（EOIB）与胸椎竖脊肌平面阻滞（ESPB）用于开胸术后疼痛的镇痛效果及安全性。
这项随机、双盲、非劣效性临床研究纳入了60例行胸外科手术的患者。患者被随机分为两组：ESPB组和EOIB组。在全身麻醉诱导后，于第5胸椎水平使用30 mL 0.25%布比卡因进行两种阻滞。主要结局指标为术后24小时内吗啡用量。次要结局指标为术后首次要求补救镇痛的时间、静息及咳嗽时的数字评分量表（NRS）评分以及并发症的发生情况。对于非正态分布变量采用非参数Wilcoxon检验，对于正态分布变量采用Student's t检验，对于定性变量采用卡方/ Fisher精确检验。显著性水平设定为≤0.05。
两组患者术中需要芬太尼的情况、首次镇痛请求时间、术后24小时内吗啡总用量以及疼痛评分相当（分别为=0.347、0.085和0.354）。两组低血压和心动过缓的发生率相当（分别为=0.353和>0.99）。两组均无患者发生局部麻醉药全身毒性反应（LAST）和气胸。
开胸术后疼痛方面，EOIB的镇痛效果不劣于ESPB，术后24小时内的总阿片类药物消耗量、首次镇痛请求时间和疼痛评分相当即证明了这一点。此外，EOIB与ESPB具有相同的安全性。
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