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超声引导下椎板后阻滞在躯干手术中的镇痛效果:一项叙述性综述。

Analgesic efficacy of ultrasound-guided retrolaminar block in truncal surgeries: A narrative review.

作者信息

Kumari Poonam, Kumar Amarjeet, Sinha Chandni, Kumar Ajeet, Singh Kunal

机构信息

Department of Anaesthesiology, AIIMS, Patna, Bihar, India.

出版信息

J Anaesthesiol Clin Pharmacol. 2024 Oct-Dec;40(4):557-563. doi: 10.4103/joacp.joacp_137_23. Epub 2024 Jul 19.

Abstract

Postoperative pain management in patients undergoing thoracoabdominal surgery always remains challenging for the anesthesiologist. As a method of pain management, multimodal analgesia is commonly used. In recent years, interfascial plane blocks like erector spine plane block (ESPB), retrolaminar block (RLB), transverse thoracic plane block, and pectointercostal plane block have been increasingly utilized as important components of acute postoperative pain management in truncal surgeries. Here, we reviewed the analgesic efficacy of ultrasound (US)-guided retrolaminar block in patients undergoing truncal surgeries. The primary objective of this review was total opioid consumption within 24 hours of the postoperative period. The secondary objectives were postoperative pain score, time to first analgesic requirement, and adverse effects. All articles relevant to the retrolaminar block were searched in six major databases (PubMed, Embase, Medline, Ovid, PMC, and Google Scholar). A total of 706 records were identified, out of which only 11 kinds of literature were included in this review article, based on our inclusion criteria. The published literature suggests that retrolaminar (RLB) provides more effective analgesia in comparison to the erector spinae block (ESP), is associated with reduced opioid consumption and numeric rating scale (NRS) score, and is not inferior to paravertebral (PVB). There is an evidence that a retrolaminar block can effectively relieve pain during truncal surgery. RLB had a lower rate of complications, was simpler to perform, and required shorter hospital stays.

摘要

对于麻醉医生来说,胸腹手术患者的术后疼痛管理一直具有挑战性。作为一种疼痛管理方法,多模式镇痛被广泛使用。近年来,诸如竖脊肌平面阻滞(ESPB)、椎板后阻滞(RLB)、胸横平面阻滞和胸肋平面阻滞等筋膜间平面阻滞越来越多地被用作躯干手术急性术后疼痛管理的重要组成部分。在此,我们回顾了超声(US)引导下椎板后阻滞在躯干手术患者中的镇痛效果。本综述的主要目标是术后24小时内的总阿片类药物消耗量。次要目标是术后疼痛评分、首次镇痛需求时间和不良反应。在六个主要数据库(PubMed、Embase、Medline、Ovid、PMC和谷歌学术)中检索了所有与椎板后阻滞相关的文章。共识别出706条记录,根据我们的纳入标准,本综述文章仅纳入了其中11种文献。已发表的文献表明,与竖脊肌阻滞(ESP)相比,椎板后阻滞(RLB)能提供更有效的镇痛,与阿片类药物消耗量和数字评分量表(NRS)评分降低相关,且不劣于椎旁阻滞(PVB)。有证据表明,椎板后阻滞可有效缓解躯干手术期间的疼痛。RLB的并发症发生率较低,操作更简单,住院时间更短。

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