竖脊肌平面阻滞对腹腔镜胆囊切除术患者术后镇痛和呼吸功能的影响：一项双盲随机对照试验

竖脊肌平面阻滞对腹腔镜胆囊切除术患者术后镇痛和呼吸功能的影响：一项双盲随机对照试验

贵州医科大学  麻醉与心脏电生理课题组

翻译：潘志军  编辑：马艳燕  审校：曹莹

研 究 目 的   Study  Objective  

腹腔镜胆囊切除术（LC）引起中度至重度术后疼痛。术后疼痛是手术后呼吸功能障碍的主要原因之一。本研究调查了竖脊肌平面（ESP）阻滞对LC患者术后镇痛和呼吸功能的影响。

试 验 设 计   Design  

前瞻性，随机，对照试验。

范 围 设 置   Setting  

健康科学大学。

受 试 人 群   Patients  

68名接受LC的成年患者。

干预 因 素   Interventions  

两组均接受同一种标准化镇痛方案。ESP阻滞组的患者则接受了额外的双侧ESP阻滞方案。

测 定 方 法   Measurements  

主要结果为术后与较低的阿片类药物需求和显著的呼吸功能改善相关的疼痛强度评估。

主 要 结 果   Main  Results  

与对照组相比，除术后2小时外，ESP阻滞组在静息和咳嗽时的数字评定量表（NRS）评分在所有时间间隔均显著降低（p<0.001）（分别为：p=0.06和p=0.13）。ESP阻滞组术后2小时和术后24小时曲马多消耗量显著低于对照组（p<0.001）。与对照组相比，ESP组在术后2小时和24小时的第一秒用力呼气量（FEV1）和用力肺活量（FVC）均无明显减少（p<0.05）。FEV1/FVC和呼气峰流速（PEFR）值在每个时间间隔内无明显差异。

结   论   Conclusions

双侧ESP阻滞为患者提供了足够的镇痛作用，并可降低LC后阿片类药物的需求量并显著改善呼吸功能；因此，我们得出结论，ESP阻滞可以添加到LC的多模式镇痛方案中。   

原始文献来源：The effect of erector spinae plane block on postoperative analgesia and respiratory function in patients undergoing laparoscopic cholecystectomy: 

A double-blind randomized controlled trial[J]. (J Clin Anesth 2021 Jul 26;74).

英文原文   

The effect of erector spinae plane block on postoperative analgesia and respiratory function in patients undergoing laparoscopic cholecystectomy: A double-blind randomized controlled trial

Study objective: Laparoscopic cholecystectomy (LC) causes moderate-to-severe postoperative pain. Postoperative pain is one of the leading contributors to respiratory dysfunction following surgery. This study investigated the effect of erector spinae plane (ESP) block on postoperative analgesia and respiratory function in patients undergoing LC. 

Design: Prospective, randomized, controlled trial. 

Setting: University of Health Science. 

Patients: Sixty-eight adult patients undergoing LC. 

Interventions: Both groups received a standardized analgesia protocol. Patients assigned to the ESP block group received an additional bilateral ESP block. 

Measurements: The primary outcome was assessed as postoperative pain intensity associated with a lower opioid requirement and significant respiratory function improvement. 

Main results: Numerical rating scale (NRS) scores both at rest and during coughing were significantly lower in the ESP block group than in the control group at all time intervals (p < 0.001 in each) except for hour 2 postoperatively (p = 0.06 and p = 0.13, respectively). Tramadol consumption at 2 h and 24 h postoperatively was significantly lower in the ESP block group than in the controls (p < 0.001 for each). There was significant preservation in forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) in the ESP group in comparison to the control group at 2 and 24 h after surgery (p < 0.05 in each). FEV1/FVC and peak expiratory flow rate (PEFR) values were similar in each time interval. 

Conclusions: Bilateral ESP blocks provides adequate analgesia, allowing for a lower opioid requirement and significant respiratory function improvement after LC; therefore, we concluded that ESP block could be added to the multimodal analgesia protocol in LC.

END 

打赏