超声引导下竖脊肌平面阻滞用于小儿脾切除术后镇痛的前瞻性随机对照试验
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Ultrasound-guided erector spinae plane block for postoperative analgesia in pediatric patients undergoing splenectomy; a prospective randomized controlled trial
背景与目的
已有研究报道许多镇痛方法已在小儿患者运用。我们研究了超声引导下双侧脊柱平面阻滞在开放性脾切除术小儿患者的镇痛效果。
方 法
60名3-10岁的患者随机分为2组：对照组采用双侧假竖脊肌平面阻滞全麻，每侧生理盐水0.3ml/kg。竖脊肌平面阻滞组采用0.25%布比卡因0.3ml/kg（双侧），以最大剂量2 mg/kg接受双侧超声引导下的竖脊肌平面阻滞。记录术后24小时CHEOPS评分、术中芬太尼总用量（镇痛不足时静脉注射芬太尼1微克/千克）、首次补救镇痛时间和术后扑热息痛用量。
结 果
竖脊肌平面阻滞组术后1h CHEOPS评分中位数（5.0（4.75-5.25））低于对照组（7.0（6.0-10.0））（P<0.001，95%CI:1.0；5.0）。竖脊肌平面阻滞组术后前8小时CHEOPS评分（5.0（5.0-6.0））低于对照组（6.0（6.0-10.0））（P˂0.001，95%CI:1.0；2.0）。对照组术中芬太尼用量为40.0μg（21.5-50.0），而脊柱平面阻滞组术中芬太尼用量为0.0μg（0.0-0.0）（P˂0.001，95%CI:23.0；48.0）。对照组术后对乙酰氨基酚总消耗量（37.5±17.1 mg/kg）高于竖脊肌平面阻滞组（8.5±10.9 mg/kg）（P˂0.001，95%CI:21.57；36.43）。竖脊肌平面阻滞组术后第一次补救镇痛所需时间较长。
结 论
超声引导下竖脊肌平面阻滞术后8小时CHEOPS评分降低、术中芬太尼和术后扑热息痛用量的减少。
原始文献摘要
Shaimaa F Mostafa, Mohamed S Abdelghany, Taysser M Abdelraheem,et,al.Ultrasound-guided erector spinae plane block for postoperative analgesia in pediatric patients undergoing splenectomy; a prospective randomized controlled trial.Paediatr Anaesth 2019 Oct 20; DOI：10.1111/pan.13758
Background: Many analgesic modalities have been investigated in pediatrics. We studied the analgesic efficacy of bilateral ultrasound-guided erector spinae plane block in pediatric patients undergoing open midline .
Methods: 60 patients aged 3- 10 years were randomly assigned into two groups: Control group received general anesthesia with bilateral sham erector spinae plane block using 0.3 ml/kg normal saline on each side. Erector spinae plane block group received bilateral ultrasound-guided erector spinae plane block using 0.3 ml/kg bupivacaine 0.25% (on each side) with a maximum dose of 2 mg/kg. Children’s Hospital Eastern Ontario Pain Scale (CHEOPS), total consumption of intraoperative fentanyl (1µg/kg IV in case of inadequate analgesia), time to first rescue analgesic administration and postoperative paracetamol consumption were recorded over the first 24 hours postoperatively.
Results: The median (IQR) postoperative CHEOPS score at 1h was lower in erector spinae plane block group (5.0 (4.75 -5.25)) than the control group (7.0 (6.0- 10.0)) (P <0.001, 95% CI: 1.0; 5.0). The CHEOPS scores for the first eight postoperative hours were lower in the erector spinae plane block group (5.0 (5.0 - 6.0)) than the control group (6.0 (6.0 -10.0)) (P ˂ 0.001, 95% CI: 1.0; 2.0). Intraoperative fentanyl administration was higher in the control group 40.0 (21.5-50.0) μg compared to erector spinae plane block group 0.0 (0.0-0.0) μg (P ˂0.001, 95% CI: 23.0; 48.0). The total postoperative paracetamol consumption was higher in the control group (37.5 ± 17.1 mg/kg) compared to erector spinae plane block group (8.5 ± 10.9 mg/kg) (P ˂ 0.001, 95% CI: 21.57; 36.43). The time to the first postoperative rescue analgesic requirement was longer in the erector spinae plane block group.
Conclusion: Ultrasound-guided erector spinae plane block reduced CHEOPS score for the first eight hours postoperatively with reduction of intraoperative fentanyl and postoperative paracetamol consumptions.
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贵州医科大学高鸿教授课题组
翻译：牛振瑛 编辑：何幼芹 审校：冯玉蓉 王贵龙
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