【罂粟摘要】超声引导下竖脊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、双盲研究
超声引导下竖脊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、双盲研究
贵州医科大学 高鸿教授课题组
翻译：佟睿 编辑：佟睿 审校：曹莹
据报道，竖脊平面阻滞(ESPB)可以有效地控制各种类型手术后的疼痛。然而，关于ESPB在肝切除术后的作用尚缺乏研究。
旨在探讨ESPB在腹腔镜肝切除术后疼痛控制中的作用，并与传统疼痛处理方法进行比较。
前瞻性随机对照研究。
2019年2月到2020年2月的三级医疗单中心。
共纳入了70例计划接受腹腔镜肝切除术的患者。
35例患者被纳入对照组，不进行神经阻滞操作。35例患者被纳入ESPB组，全麻诱导后行ESPB，在T9水平双侧注射共40ml 0.5%罗哌卡因。手术后，开始使用静脉注射芬太尼患者自控镇痛泵进行术后镇痛。给予芬太尼和氢吗啡酮作为解救性镇痛药。
主要观察指标是术后24小时累计阿片类药物消耗(吗啡当量)。次要观察指标是麻醉后恢复室(PACU)的阿片类药物(芬太尼)抢救剂量和1、6、12、24、48和72小时的疼痛严重程度，使用数值评分表(NRS)评分进行评估。
术后24小时内，对照组的中位[IQR]术后阿片类药物消耗量为48.2 [17.1]mg, ESPB组为45.5 [35.8]mg(中位数差异 4.2 mg; 95% CI: -4.2~13.3 mg; P=0.259)。相反，PACU中阿片类抢救剂量在对照组中为5.3 [5.0]mg，在ESPB组中为3.0 [1.5]mg(中位数差异 2.5 mg; 95% CI: 1.0~5.0 mg; P<0.001)。两组在不同时间点的NRS评分无显著性差异。
腹腔镜肝切除术后24h内，ESPB无镇痛作用。
Doyeon Kim, Jong Man Kim, Gyu-Seong Choi, et al. Ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic liver resection: A prospective, randomised controlled, patient and observer-blinded study.[J].Eur J Anaesthesiol 2021; 38 (Suppl 2):S106–S112.
Ultrasound-guided erector spinae plane block for postoperative analgesia in laparoscopic liver resection: A prospective, randomised controlled, patient and observer-blinded study
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)
Published online 1 March 2021
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