超声引导竖脊肌平面阻滞用于腹腔镜肝切除术后镇痛：一项前瞻性、随机对照、患者和观察者盲法研究。

Ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic liver resection: A prospective, randomised controlled, patient and observer-blinded study.

机构信息

From the Department of Anesthesiology and Pain Medicine (DK, GH, GSK, JSJ) and Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (JMK, G-SC).

出版信息

Eur J Anaesthesiol. 2021 Aug 1;38(Suppl 2):S106-S112. doi: 10.1097/EJA.0000000000001475.

DOI:10.1097/EJA.0000000000001475

PMID:33653982

Abstract

BACKGROUND

Erector spinae plane block (ESPB) has been reported to manage postoperative pain effectively after various types of surgery. However, there has been a lack of study on the effect of ESPB after liver resection.

OBJECTIVES

To investigate the analgesic effects of ESPB on pain control after laparoscopic liver resection compared with conventional pain management.

DESIGN

Prospective, randomised controlled study.

SETTING

A single tertiary care centre from February 2019 to February 2020.

PATIENTS

A total of 70 patients scheduled to undergo laparoscopic liver resection.

INTERVENTIONS

In the control group (n = 35), no procedure was performed. In the ESPB group (n = 35), ESPB was performed after induction of general anaesthesia. A total of 40 ml of ropivacaine 0.5% was injected at the T9 level bilaterally. After surgery, intravenous fentanyl patient-controlled analgesia was initiated. Fentanyl and hydromorphone were administered as rescue analgesics.

MAIN OUTCOME MEASURES

The primary outcome was the cumulative postoperative opioid consumption at 24 h (morphine equivalent). The secondary outcomes were rescue opioid (fentanyl) dose in the postanaesthesia care unit (PACU) and pain severity at 1, 6, 12, 24, 48 and 72 h, assessed using a numerical rating scale (NRS) score.

RESULTS

The median [IQR] postoperative opioid consumption during 24 hours following surgery was 48.2 [17.1] mg in the control group and 45.5 [35.8] mg in the ESPB group (median difference, 4.2 mg; 95% CI, -4.2 to 13.3 mg; P = 0.259). Conversely, rescue opioid in PACU was 5.3 [5.0] mg in the control group and 3.0 [1.5] mg in the ESPB group (median difference, 2.5 mg; 95% CI, 1.0 to 5.0 mg; P < 0.001). There was no significant difference in NRS scores point between the groups at any time.

CONCLUSION

ESPB does not provide analgesic effect within 24 h after laparoscopic liver resection.

TRIAL REGISTRATION

Clinical Trial Registry of Korea (https://cris.nih.go.kr.), identifier: KCT0003549).

摘要

背景

竖脊肌平面阻滞（ESPB）已被报道可有效管理各种类型手术后的术后疼痛。然而，对于肝切除术后 ESPB 的效果，仍缺乏研究。

目的

研究 ESPB 对腹腔镜肝切除术后疼痛控制的效果与常规疼痛管理相比。

设计

前瞻性、随机对照研究。

地点

2019 年 2 月至 2020 年 2 月，一家单一的三级护理中心。

患者

总共 70 例计划接受腹腔镜肝切除术的患者。

干预

在对照组（n=35）中，不进行任何操作。在 ESPB 组（n=35）中，在全身麻醉诱导后进行 ESPB。双侧 T9 水平注射总共 40ml 0.5%罗哌卡因。手术后，开始静脉注射芬太尼患者自控镇痛。芬太尼和氢吗啡酮作为解救镇痛药。

主要观察指标

主要结局是 24 小时内累积术后阿片类药物消耗量（吗啡当量）。次要结局是术后恢复室（PACU）中解救阿片类药物（芬太尼）剂量以及术后 1、6、12、24、48 和 72 小时的疼痛严重程度，使用数字评分量表（NRS）评分评估。

结果

术后 24 小时内，对照组的术后阿片类药物总消耗量中位数[IQR]为 48.2[17.1]mg，ESPB 组为 45.5[35.8]mg（中位数差异，4.2mg；95%CI，-4.2 至 13.3mg；P=0.259）。相反，对照组 PACU 中的解救阿片类药物为 5.3[5.0]mg，ESPB 组为 3.0[1.5]mg（中位数差异，2.5mg；95%CI，1.0 至 5.0mg；P<0.001）。两组在任何时间的 NRS 评分点均无显著差异。