【周五】經(jīng)典高分文獻閱讀·超聲引導下豎脊肌平面阻滯用于腹腔鏡肝切除術(shù)術(shù)后鎮(zhèn)痛前瞻、隨機對照、雙盲研究

2021.12.06

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超聲引導下豎脊肌平面阻滯用于腹腔鏡肝切除術(shù)的術(shù)后鎮(zhèn)痛

一項前瞻性、隨機對照、患者與觀察者雙盲研究

翻譯：苗丹尼

01

背景

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.

背景：豎脊肌平面阻滯(ESPB)已被報道可有效應用于各種手術(shù)后的術(shù)后疼痛。然而，關于肝切除術(shù)后ESPB效果的研究一直是缺乏報道。

02

方法

OBJECTIVES To investigate the analgesic effects of ESPB on pain control after laparoscopic liver resection compared with conventional pain management.

目的：探討腹腔鏡下肝切除術(shù)后，與常規(guī)疼痛管理方法比較，使用豎脊肌平面阻滯控制疼痛的效果。

DESIGN Prospective, randomised controlled study.

設計：前瞻性、隨機對照研究。

SETTINGA single tertiary care centre from February 2019 to February 2020.

試驗地點和時間：三級醫(yī)療中心，從2019年2月至2020年2月。

PATIENTS A total of 70 patients scheduled to undergo laparoscopic liver resection.

病人：共有70例患者計劃行腹腔鏡肝切除術(shù)。

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 40ml 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.

干預措施:對照組(n = 35)未進行疼痛干預。

ESPB組(n = 35)在全麻誘導后進行ESPB。共40ml 0.5%羅哌卡因在T9水平雙側(cè)注射。

手術(shù)后，開始使用芬太尼靜脈自控鎮(zhèn)痛。給予芬太尼和氫嗎啡酮作為補救性鎮(zhèn)痛藥。

MAIN OUTCOME MEASURES The primary outcome was the cumulative postoperative opioid consumption at 24h (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 72h, assessed using a numerical rating scale (NRS) score.

主要結(jié)局指標：

主要結(jié)局指標是術(shù)后24小時阿片類藥物累計消耗量(嗎啡等效劑量)。

次要結(jié)局指標是麻醉后恢復室(PACU)的阿片類藥物(芬太尼)補救性使用劑量和1、6、12、24、48和72小時的疼痛嚴重程度，使用數(shù)字評分量表(NRS)進行評估。

Table&Figure

圖1流程圖

表1病人特征

表2術(shù)中和術(shù)后數(shù)據(jù)資料

圖2術(shù)后不同時間數(shù)字評分量表得分

03

結(jié)果

RESULTS The median [IQR] cumulative postoperative opioid consumption at 24h 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 2.5mg, 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.

結(jié)果：對照組術(shù)后24小時阿片類藥物累計消耗量的中位數(shù)[四分位間距]為48.2 [17.1]mg, ESPB組為45.5 [35.8]mg(中位數(shù)差異，4.2 mg, 95% CI，－4.2—13.3 mg, P = 0.259)。