无阿片类药物麻醉下竖脊肌平面神经阻滞在肝硬化肝切除患者中的应用：一项随机对照试验

无阿片类药物麻醉下竖脊肌平面神经阻滞在肝硬化肝切除患者中的应用：一项随机对照试验

贵州医科大学  麻醉与心脏电生理课题组

翻译：安丽   编辑：张中伟   审校：曹莹

  01   背景

肝切除术是腹部一类大手术，对疼痛管理具有挑战性。我们旨在研究拟行肝切除术的患者采用无阿片药麻醉（OFA）下进行竖脊肌平面阻滞（ESPB）的围手术期疼痛管理对血流动力学稳定性方面的影响。其次，我们评估了手术后24小时内首次要求镇痛的时间和围手术期芬太尼的用量，及术后恶心和呕吐的发生情况。

  02   方法

选择40例因肝硬化行肝切除术患者，随机分为两组：阻滞组：OFA联合ESPB（n=20）和常规组：常规组阿片类药物平衡麻醉（n=20）。（OFA相关非阿片类药物：右美托咪定、硫酸镁、利多卡因和乙酰氨基酚）。双侧竖脊肌平面阻滞（ESPB）：在胸椎T 6-7水平进行超声引导予0.25%布比卡因加右美托咪定(0.5 g/kg)20ml阻滞麻醉。并监测心率、平均动脉血压和心输出量相关血流动力学指标。

  03   结果

双侧ESPB为肝切除患者提供躯体和内脏镇痛，术中无需芬太尼。术后，右美托咪定辅助局部麻醉药物的阻滞组首次镇痛请求延迟（p=0.092），芬太尼需求量减少（p<0.001），因此ESPB组术后无恶心呕吐发生，而常规组为50%（p<0.001）。

    0 4 结论

双侧OFA联合ESPB是肝切除术后肝硬化患者术中和术后镇痛的有效途径。

  0 5 原始文献来源

Minatallah A Elshafie , Magdy K Khalil, Maha L ElSheikh, Nagwa I Mowafy.Erector Spinae Block with Opioid Free Anesthesia in Cirrhotic Patients Undergoing Hepatic Resection: A Randomized Controlled Trial.Local Reg Anesth 2022;15.DOI：10.2147/LRA.S343347. 

英文原文    

Erector Spinae Block with Opioid Free Anesthesia in Cirrhotic Patients Undergoing Hepatic Resection: A Randomized Controlled Trial

Abstract

Background:Hepatic resection is a major abdominal surgery with challenging pain management. We aimed to investigate the effectof erector spinae plane block (ESPB) with opioid free anesthesia (OFA) in cirrhotic patients scheduled for liver resection onperioperative pain management in terms of hemodynamic stability. Secondarily, we assessed time to first request for analgesia andperioperative fentanyl consumption, nausea and vomiting within 24 hours after surgery.

Methods:Forty patients were randomized to block group (n = 20): OFA with ESPB and conventional group (n = 20): conventionalbalanced anesthesia with opioids (OFA associated non-opioid drugs [dexmedetomidine, magnesium sulfate, xylocaine, and acetaminophen] and ESPB). Bilateral ESP block was done with ultrasound guidance at the level of thoracic vertebrae T 6–7, the localanesthetic dose was 20 mL Bupivacaine 0.25% with adjuvant dexmedetomidine (0.5 µg/kg) on each side. We monitored hemodynamicstability as the primary endpoint (heart rate, mean arterial blood pressure, and cardiac output).

Results:Bilateral ESPB offered somatic and visceral analgesia for hepatic resection patients with no intraoperative fentanyl required.Postoperatively, the block group with dexmedetomidine adjuvant to the local anesthesia drugs showed delay in the first request foranalgesia (p = 0.092) and decreased fentanyl requirement (p < 0.001), so no patient in the ESP group suffered from postoperativenausea and vomiting compared to 50% in the conventional group (p < 0.001).

Conclusions:Bilateral ESP block with OFA is an effective approach for intra- and postoperative analgesia in cirrhotic patientsundergoing liver resection.

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