【原】【罂粟摘要】竖脊肌平面阻滞用于二尖瓣微创手术的有效性：一项双盲、前瞻性、随机、安慰剂对照试验

竖脊肌平面阻滞用于二尖瓣微创手术的有效性：一项双盲、前瞻性、随机、安慰剂对照试验

贵州医科大学    麻醉与心脏电生理课题组

翻译：潘志军      编辑：宋雨婷     审校：曹莹

研究目的

探讨竖脊肌平面(ESP)阻滞能否减少二尖瓣微创手术(MIMVS)患者术后阿片类药物用量、减轻疼痛和术后恶心呕吐。

试验设计及范围设置

本试验为一项单中心、双盲、前瞻性、随机、安慰剂对照试验。试验范围设置为术后；某大学医院的手术室、麻醉恢复室(PACU)和病房。

受试对象

72例患者经右侧胸壁小切口行胸腔镜MIMVS并纳入心脏外科术后加速康复计划。

干预措施及测量方法

手术结束后，所有患者在超声引导下于T₅椎体置入ESP导管，并随机给予0.5% (负荷剂量30ml，间隔6h追加3次剂量20ml)罗哌卡因或0.9% (具有相同的管理方案)生理盐水。此外，患者接受包括地塞米松、对乙酰氨基酚和吗啡静脉自控镇痛在内的多模式术后镇痛。在最后一次ESP推注完毕并拔除导管前，通过超声重新评估导管位置。整个试验过程中对患者、调查员和医务人员进行盲法分组。主要结局指标为拔管后24 h内吗啡累积消耗量。次要结局指标包括疼痛严重程度、感觉阻滞存在/程度、术后通气时间和住院时间。安全性结局包括不良事件发生率。

结果

干预组和对照组24h吗啡消耗量中位数(IQR)分别为41mg (30~55)和37mg (29~50) (P =0.70)，差异无统计学意义。同样，次要和安全结局指标也未发现差异。

结论

在MIMVS后，在标准多模式镇痛方案中加入ESP阻滞并不能减少阿片类药物的用量和疼痛评分。

原始文献来源：

Danny Feike Hoogma,Raf Van den Eynde, Layth Al Tmimi,et al.Efficacy of erector spinae plane block for minimally invasive mitral valve surgery: Results of a double-blind, prospective randomized placebo-controlled trial [J]. (J Clin Anesth. 2023 Jun;86:111072.).

英文原文

Efficacy of erector spinae plane block for minimally invasive mitral valve surgery: Results of a double-blind, prospective randomized placebo-controlled trial       

Study objective: To investigate if an erector spinae plane (ESP) block decreases postoperative opioid consumption, pain and postoperative nausea and vomiting in patients undergoing minimally invasive mitral valve surgery (MIMVS).

Design: A single-center, double-blind, prospective, randomized, placebo-controlled trial.

Setting: Postoperative period; operating room, post-anesthesia care unit (PACU) and hospital ward in a university hospital.

Patients: Seventy-two patients undergoing video-assisted thoracoscopic MIMVS via right-sided mini-thoracotomy and enrolled in the institutional enhanced recovery after cardiac surgery program.

Interventions: At the end of surgery, all patients received an ESP catheter at vertebra T5 under ultrasound guidance and were randomized to the administration of either ropivacaine 0.5% (loading of dose 30 ml and three additional doses of 20 ml with a 6 h interval) or normal saline 0.9% (with an identical administration scheme). In addition, patients received multimodal postoperative analgesia including dexamethasone, acetaminophen and patient-controlled intravenous analgesia with morphine. Following the final ESP bolus and before catheter removal, the position of the catheter was re-evaluated by ultrasound. Patients, investigators and medical

personnel were blinded for the group allocation during the entire trial.

Measurements: Primary outcome was cumulative morphine consumption during the first 24 h after extubation. Secondary outcomes included severity of pain, presence/extent of sensory block, duration of postoperative ventilation and hospital length of stay. Safety outcomes comprised the incidence of adverse events.

Main results: Median (IQR) 24-h morphine consumption was not different between the intervention- and controlgroup, 41 mg (30–55) versus 37 mg (29–50) (p = 0.70), respectively. Likewise, no differences were detected for secondary and safety endpoints.

Conclusions: Following MIMVS, adding an ESP block to a standard multimodal analgesia regimen did not reduce opioid consumption and pain scores.

-End-