超声引导下双侧竖脊肌平面阻滞在腰椎融合术患者中的应用：随机对照试验
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超声引导下双侧竖脊肌平面阻滞在腰椎融合术患者中的应用：随机对照试验
翻译：冯玉蓉 编辑：冯玉蓉 审校：曹莹
研究目的：脊柱融合术常伴有剧烈的术后疼痛。我们研究了超声引导下双侧竖脊肌平面阻滞是否能减轻腰椎融合术患者的术后疼痛。
设计：盲法、随机、对照研究。
机构：三级综合大学附属医院、手术室、术后恢复室、病房。
患者：60例拟行腰椎融合术的ASA分级I级或II级的患者，按1:1的比例随机分为竖脊肌平面阻滞组（ESPB组）和对照组。
干预措施：ESPB组术前行超声引导下双侧竖脊肌平面阻滞，对照组行假手术皮下浸润。
测量指标：主要结果为术后12小时内静息时的疼痛强度，采用数值评定量表(NRS)评估。次要结果包括静息时和运动时的NRS疼痛评分、术后阿片类药物消耗量和手术后48小时内需要阿片类药物的患者比例。
主要结果：ESPB组（n=30）在术后4h（估计平均差−1.6，95%CI -2.4~ -0.8，p<0.001）、8h（−1.3，95%CI-1.9~-0.6，p<0.001）和12h（−0.7，95%CI-1.3~ -0.1，p=0.023）的静息疼痛评分显著降低。两组患者在术后24小时（估计平均差为-0.2，95%CI -0.8~ -0.5）和48小时（-0.3，95%CI -0.8~ -0.2）的静息疼痛评分相似。ESPB组在术后4小时的运动疼痛评分也显著降低（−1.5，95%CI -2.5~ -0.6）。ESPB组术后12小时内需要舒芬太尼的患者比例明显较小（p=0.020），该组在此期间消耗的舒芬太尼明显较少（p=0.042）。
结论：超声引导下双侧竖脊肌平面阻滞可改善腰椎融合患者的术后镇痛效果。
文献来源：Zhang Q, Wu Y, Ren F, et al. Bilateral ultrasound-guided erector spinae plane block in patients undergoing lumbar spinal fusion: A randomized controlled trial.[J].J Clin Anesth. 2020 Oct 20;68:110090. doi: 10.1016/j.jclinane.2020.110090.
Bilateral ultrasound-guided erector spinae plane block in patients undergoing lumbar spinal fusion: A randomized controlled trial
ABSTRACT
Study objective: Spinal fusion surgery is associated with severe postoperative pain. We examined whether bilateral ultrasound-guided erector spinae plane block could alleviate postoperative pain in patients undergoing lumbar spinal fusion.
Design: Blinded, randomized, controlled study.
Setting: Tertiary university hospital, operating room, postoperative recovery room and ward.
Patients: Sixty patients with American Society of Anesthesiologists grade I or II scheduled for lumbar spinal fusion surgery were randomized into the erector spinae plane block group (ESPB group) and the control group in a 1:1 ratio.
Interventions: Pre-operative ultrasound-guided bilateral erector spinae plane block was performed in the ESPB group, while sham subcutaneous infiltration was performed in the control group.
Measurements: The primary outcome was pain intensity at rest within 12 h postoperatively using the Numeric Rating Scale (NRS). Secondary outcomes included NRS pain scores at rest and on movement, postoperative opioid consumption and proportions of patients requiring opioid during the first 48 h after surgery.
Main results: The ESPB group (n = 30) showed significantly lower pain scores at rest at 4 h after surgery (estimated mean difference − 1.6, 95% confidence interval [CI] -2.4 to −0.8, p < 0.001), at 8 h (−1.3, 95% CI -1.9 to −0.6, p < 0.001), and at 12 h (−0.7, 95% CI -1.3 to −0.1, p = 0.023). The two groups showed similar pain scores at rest at 24 h after surgery (estimated mean difference − 0.2, 95% CI -0.8 to 0.5) and 48 h (−0.3, 95% CI -0.8 to 0.2). The ESPB group also showed significantly lower pain score on movement at 4 h after surgery (−1.5, 95% CI -2.5 to −0.6). The ESPB group showed a significantly smaller proportion of patients requiring sufentanil within 12 h after surgery (p = 0.020), and the group consumed significantly less sufentanil during that period (p = 0.042).
Conclusions: Bilateral ultrasound-guided erector spinae plane block improves postoperative analgesia in patients undergoing lumbar spinal fusion.
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