超声引导下双侧胸横肌平面阻滞在小儿心脏手术中镇痛效果的评价

研究目的：充分的围术期镇痛对于接受心脏手术的儿童来说是必须的，静脉注射阿片类药物和神经干阻滞技术已被使用，但没有得到普及，本研究的目的是评价经胸横肌平面(TTP)阻滞在小儿心脏手术中的镇痛效果。

设计：优势、随机、双盲、对照研究。

机构：埃及曼苏拉大学儿童医院重症监护病房(ICU)术中和术后。

受试者： 将80例2-12岁经胸骨正中切开行心脏手术的儿童随机分为对照组和TTP阻滞组。

干预措施：对照组仅给予芬太尼进行围术期镇痛，而干预组(TTP组)则行TTP阻滞。

测量指标：主要观察指标为拔管后术后24小时内使用芬太尼的总剂量，次要观察指标为术后疼痛评分、术中芬太尼用量、拔管时间和ICU住院时间。

主要结果：术后24小时内，TTP阻滞组芬太尼的总用量（9.892±3.397μg/ kg）显着低于对照组（18.500±3.401μg/ kg）（P <0.05）；TTP阻滞组改良客观疼痛评分始终显著低于对照组（P <0.05）；术中芬太尼总使用量TTP阻滞组（8.27±1.170μg/ kg）显著降低对照组（13.72±1.186μg/ kg）（P <0.05）。

结论：TTP阻滞减少了小儿心脏手术围术期芬太尼用量，也减轻了术后疼痛强度。

原始文献来源: Abdelbaser II,  Mageed NA,et al.Analgesic efficacy of ultrasound guided bilateral transversus thoracis muscle plane block in pediatric cardiac surgery: a randomized, double-blind, controlled study.[J].J Clin Anesth 2020 Jul 24;67.

Analgesic efficacy of ultrasound guided bilateral transversus thoracis muscle plane block in pediatric cardiac surgery: a randomized, double-blind,controlled study

Abstract

Study objective: Adequate perioperative pain control in children undergoing cardiac surgery is mandatory. Intravenous opioids and neuraxial anesthetic techniques have been used but didn't gained any popularity. The aim of the current study was to evaluate the analgesic efficacy of transversus thoracis plane (TTP) block in pediatric cardiac surgery.

Design: Superiority, randomized, double-blind, controlled study.

Setting: Intraoperative and postoperative in intensive care unit (ICU), Mansoura university children hospital, Egypt.

Patients: Eighty pediatric patients aged 2–12 years, undergoing cardiac surgery via median sternotomy, were randomly allocated into 2 equal groups, the control group and TTP block group.

Interventions: Controlled group received only fentanyl for perioperative analgesia, while TTP block was performed in the intervention group (TTP group).

Measurements: The primary outcome measure was the total dose of fentanyl in the first postoperative 24 h after extubation, while the secondary outcome measures were postoperative pain score, intraoperative fentanyl consumption, time to extubation and ICU length of stay.

Main results: During the first postoperative 24 h, total fentanyl consumption was significantly lower (P < 0.05) in the TTP block group (9.892 ± 3.397 μg/kg) than the control group (18.500 ± 3.401 μg/kg) and modified objective pain score was significantly (P < 0.05) lower in TTP block group than the control group all over the time. Total intraoperative fentanyl requirement was significantly (P < 0.05) lower in TTP block group (8.27 ± 1.170 μg/kg) than the control group(13.72 ± 1.186 μg/kg).

Conclusion: The use of TTP block decreased perioperative fentanyl consumption and reduced postoperative pain intensity.