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Erector spinae plane block versus quadratus lumborum block for postoperative analgesia after laparoscopic nephrectomy: A randomized controlled trial 竖脊肌平面阻滞与腰方肌阻滞用于腹腔镜肾切除术后镇痛:一项随机对照试验 Study objective: We compared the analgesic effects of erector spinae plane block versus quadratus lumborum block following laparoscopic nephrectomy. 研究目的:比较腹腔镜肾切除术后竖脊肌平面阻滞与腰方肌阻滞的镇痛效果。 Design: A randomized controlled trial. 设计:随机对照试验。 Setting: A tertiary hospital in Beijing, China. 地点:中国北京某三级医院。 Patients: Patients scheduled for elective laparoscopic nephrectomy. 患者:计划择期腹腔镜肾切除术患者。 Interventions: A total of 110 patients were enrolled and randomized to receive either erector spinae plane block (n = 55) or quadratus lumborum block (n = 55) under ultrasound guidance. Patient-controlled sufentanil analgesia was provided after surgery. 干预措施:共纳入110例患者，随机分为两组，在超声引导下接受竖脊肌平面阻滞(n = 55)或腰方肌阻滞(n = 55)。术后给予患者自行控制的舒芬太尼镇痛。 Measurements: Our primary outcome was cumulative opioid consumption within 24 h after surgery. Secondary outcomes included postoperative pain intensity, subjective sleep quality, and quality of recovery. Main results: All 110 patients (mean 53 years, 57.3% female) were included in the intention-to-treat analysis. Cumulative sufentanil equivalent within 24 h was lower in patients given erector spinae plane block (median 13 μg, interquartile range 4 to 33) than in those given quadratus lumborum block (median 25 μg, interquartile range 13 to 39; median difference − 8 μg, 95% CI -15 to 0, P = 0.041). Pain intensity (0–10 range where 0 = no pain and 10 = the worst pain) at 2, 6, 12, and 24 h after surgery was lower with erector spinae plane block (at rest: median differences −1 point, all P ≤ 0.009; with movement: median differences −2 to −1 points, all P < 0.001). Subjective sleep quality on the night of surgery (the Richards-Campbell Sleep Questionnaire: 0–100 range, higher score better; median difference 12, 95% CI 2 to 23, P = 0.018) and quality of recovery at 24 h (the Quality of Recovery-15: 0–150 range, higher score better; median difference 8, 95% CI 2 to 15, P = 0.012) were better with erector spinae plane block. No procedure-related adverse events occurred. 测量:我们的主要结果是术后24小时内阿片类药物的累积消耗。次要结局包括术后疼痛强度、主观睡眠质量和恢复质量。主要结果:所有110例患者(平均53岁，女性57.3%)均纳入意向治疗分析。24 h内累积舒芬太尼当量在竖脊肌平面阻滞组(中位数13 μg，四分位数范围4 ~ 33)低于腰方肌阻滞组(中位数25 μg，四分位数范围13 ~ 39;中位差为- 8 μg, 95% CI为-15 ~ 0,P = 0.041)。术后2、6、12、24 h，竖棘平面阻滞组疼痛强度(0 - 10范围，0 =无疼痛，10 =疼痛最严重)较低(休息时:中位差- 1点，均P≤0.009;随运动:中位数差- 2至- 1点，均P < 0.001)。手术当晚主观睡眠质量(Richards-Campbell睡眠问卷:0-100分，得分越高越好;中位数差12,95% CI 2 ~ 23, P = 0.018)和24 h的恢复质量(恢复质量-15:0 ~ 150范围，分值越高越好;中位差为8,95% CI为2 ~ 15,P = 0.012)。无手术相关不良事件发生。 Conclusions: Compared with quadratus lumborum block, erector spinae plane block provided better analgesia as manifested by lower opioid consumption and pain intensity for up to 24 h after laparoscopic nephrectomy. 结论:与腰方肌阻滞相比，竖脊肌平面阻滞在腹腔镜肾切除术后24 h内镇痛效果更好，表现为阿片类药物消耗更低，疼痛强度更低。 结果 3.1. Efficacy outcomes The equivalent dose of sufentanil consumption within 24 h after surgery was lower in patients given ESPB (median 13 μg, interquartile range [IQR] 4 to 33) than in those given QLB (median 25 μg, IQR 13 to 39; median difference − 8 μg, 95% CI -15 to 0; P = 0.041) (Table 2). Among secondary outcomes, pain intensity at rest was lower in the ESPB group than in the QLB group at 2, 6, 12, and 24 h after surgery (median differences −1 point, all P ≤ 0.009; Fig. 3A; Supplement Table S2); pain intensity with movement was also lower in the ESPB group at 2, 6, 12, and 24 h after surgery (median differences from −2 to −1 points, all P < 0.001; Fig. 3B; Supplement Table S2). Both sleep quality during the night of surgery (median difference 12 points, 95% CI 2 to 23; P = 0.018) and quality of recovery at 24 h after surgery (median difference 8 points, 95% CI 2 to 15; P = 0.012) were higher (better) in the ESPB group. Length of hospital stay after surgery and occurrence of postoperative complications during hospital stay did not differ between the two groups (Table 2). Among other and exploratory outcomes, sufentanil equivalent within 48 h (median difference − 8 μg, 95% CI -20 to 0; P = 0.072) and the number of required PCA boluses within 48 h (median difference − 3, 95% CI -9 to 0; P = 0.060) were slightly lower in patients given ESPB, although not significantly so (Fig. 3C; Supplement Fig. S1). Both the AUC of pain intensity within 48 h (at rest: median difference − 47, 95% CI -78 to −23; P = 0.001; with movement: median difference − 57, 95% CI -84 to −32; P < 0.001) and the PIOC within 48 h (at rest: median difference − 63.1%, 95% CI -100.9% to −19.8%; P = 0.004; with movement: median difference − 68.5%, 95% CI -109.9% to −25.2%; P = 0.001) were lower in the ESPB group (Table 2). 3.1. 疗效结果:ESPB组术后24 h内舒芬太尼等效剂量(中位数13 μg，四分位间距[IQR] 4 ~ 33)低于QLB组(中位数25 μg, IQR 13 ~ 39;中位差- 8 μg, 95% CI -15 ~ 0;P = 0.041)(表2)。在次要结局中，ESPB组在术后2、6、12和24 h的休息时疼痛强度低于QLB组(中位差- 1点，P≤0.009;图3A;补充表S2);ESPB组在术后2、6、12和24小时运动时疼痛强度也较低(中位差为- 2至- 1点，均P < 0.001;图3B;补充表S2)。两组患者手术当晚的睡眠质量(中位差12点，95% CI 2 ~ 23;P = 0.018)和术后24 h恢复质量(中位差8点，95% CI 2 ~ 15;P = 0.012)， ESPB组较高(较好)。两组术后住院时间和住院期间术后并发症发生率无差异(表2)。在其他和探索性结果中，48 h内舒芬太尼当量(中位差- 8 μg, 95% CI -20 ~ 0;P = 0.072)和48 h内所需PCA丸数(中位数差值为- 3,95% CI为-9至0;P = 0.060)稍低，但不明显(图3C;补充图S1)。48小时内疼痛强度AUC(静息时:中位数差- 47,95% CI -78 ~ - 23;P = 0.001;运动:中位差为- 57,95% CI为-84至- 32;P < 0.001)和48小时内的PIOC(静止时:中位数差值为- 63.1%，95% CI为-100.9%至- 19.8%;P = 0.004;伴运动:中位差- 68.5%，95% CI -109.9%至- 25.2%;P = 0.001)较ESPB组低(表2)。 3.2. Safety outcomes The occurrence of adverse events was similar between the two groups (Table 3). No nerve block-related side effects including local anesthetic intoxication and hematoma were observed. No severe adverse events occurred during the study period. 3.2. 两组不良事件的发生相似(表3)。未观察到神经阻滞相关的副作用，包括局部麻醉中毒和血肿。研究期间未发生严重不良事件。    Refer 文章：徐宁 排版：肉肉 |
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