竖脊肌平面阻滞和胸肌神经阻滞用于二尖瓣/三尖瓣修补术患者术后疼痛治疗的随机对照试验
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Postoperative pain treatment with erector spinae plane block and pectoralis nerve blocks in patients undergoing mitral/tricuspid valve repair：a randomized controlled trial
背景与目的
对于接受心脏手术的患者来说，有效的术后疼痛控制仍然是一个挑战。区域阻滞可能会改善这类患者的疼痛管理，并可以缩短他们的住院时间。本研究的目的是比较竖棘肌平面(ESP)阻滞和ESP与胸肌神经(PECS)联合阻滞对心脏手术患者术后疼痛强度的影响。
方 法
这是一项在三甲医院进行的前瞻性、随机、对照、双盲研究。30例微创二尖瓣/三尖瓣修补术的患者随机分为两组，ESP组或PECS+ESP组(1：1)。两组患者都接受了单次、超声引导下的ESP阻滞。PECS+ESP组的患者额外接受PECS阻滞。每个病人须在手术结束后2小时内拔管，术后使用自控止痛泵(PCA)治疗。主要结果是术后第一天通过PCA使用羟考酮的总消耗量。次要结果包括VAS疼痛强度评分、患者满意度、PHHPS评分和肺活量测量。
结 果
PECS+ESP组患者使用羟考酮的量明显少于ESP组：中位数12[四分位数间距：6-16]毫克VS 20[四分位数间距：18-29]毫克(p=0.0004)。此外，术后第一天PECS+ESP组五项测量中每一项的疼痛强度都显著低于ESP组。PECS+ESP组患者对疼痛治疗的满意度较高。PHHPS和肺活量测定两组间差异无统计学意义(P>0.05)。
结 论
ESP联合PECS阻滞减少术后PCA羟考酮的消耗，降低VAS疼痛强度评分，并提高患者对微创二尖瓣/三尖瓣修复术术后疼痛管理的满意度。
原始文献摘要
Gawęda B, Borys M, Belina B,Postoperative pain treatment with erector spinae plane block and pectoralis nerve blocks in patients undergoing mitral/tricuspid valve repair：a randomized controlled trial.BMC Anesthesiol 2020 Feb 27;20(1).DOL:10.1186/s12871-020-00961-8.
Background: Effective postoperative pain control remains a challenge for patients undergoing cardiac surgery.Novel regional blocks may improve pain management for such patients and can shorten their length of stay in the hospital.To compare postoperative pain intensity in patients undergoing cardiac surgery with either erector spinae plane(ESP) block or combined ESP and pectoralis nerve (PECS) blocks.
Methods: This was a prospective, randomized, controlled, double-blinded study done in a tertiary hospital. Thirty patients undergoing mitral/tricuspid valve repair via mini-thoracotomy were included. Patients were randomly allocated to one of two groups: ESP or PECS + ESP group (1:1 randomization). Patients in both groups received a single-shot, ultrasound-guided ESP block. Participants in PECS + ESP group received additional PECS blocks. Each patient had to be extubated within 2 h from the end of the surgery. Pain was treated via a patient-controlled analgesia (PCA) pump. The primary outcome was the total oxycodone consumption via PCA during the first postoperative day. The secondary outcomes included pain intensity measured on the visual analog scale (VAS),patient satisfaction, Prince Henry Hospital Pain Score (PHHPS), and spirometry.
Results: Patients in the PECS + ESP group used significantly less oxycodone than those in the ESP group: median 12 [interquartile range (IQR): 6–16] mg vs. 20 [IQR: 18–29] mg (p = 0.0004). Moreover, pain intensity was significantly lower in the PECS + ESP group at each of the five measurements during the first postoperative day. Patients in the PECS + ESP group were more satisfied with pain management. No difference was noticed between both groups in PHHPS and spirometry.
Conclusions: The addition of PECS blocks to ESP reduced consumption of oxycodone via PCA, reduced pain intensity on the VAS, and increased patient satisfaction with pain management in patients undergoing mitral/ tricuspid valve repair via mini-thoracotomy.
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翻译：何幼芹 编辑：冯玉蓉 审校：王贵龙