Abstract：
Minimally invasive cardiac surgery provokes substantial pain and therefore analgesic consumption. The effect of fascial plane blocks on analgesic efficacy and overall patient satisfaction remains unclear. We therefore tested the primary hypothesis that fascial plane blocks improve overall benefit analgesia score (OBAS) during the initial 3 days after robotically assisted mitral valve repair. Secondarily, we tested the hypotheses that blocks reduce opioid consumption and improve respiratory mechanics.
Adults scheduled for robotically assisted mitral valve repairs were randomised to combined pectoralis II and serratus anterior plane blocks or to routine analgesia. The blocks were ultrasound-guided and used a mixture of plain and liposomal bupivacaine. OBAS was measured daily on postoperative Days 1-3 and were analysed with linear mixed effects modelling. Opioid consumption was assessed with a simple linear regression model and respiratory mechanics with a linear mixed model.
As planned, we enrolled 194 patients, with 98 assigned to blocks and 96 to routine analgesic management. There was neither time-by-treatment interaction (P=0.67) nor treatment effect on total OBAS over postoperative Days 1-3 with a median difference of 0.08 (95% confidence interval [CI]: -0.50 to 0.67; P=0.69) and an estimated ratio of geometric means of 0.98 (95% CI: 0.85-1.13; P=0.75). There was no evidence of a treatment effect on cumulative opioid consumption or respiratory mechanics. Average pain scores on each postoperative day were similarly low in both groups.
Serratus anterior and pectoralis plane blocks did not improve postoperative analgesia, cumulative opioid consumption, or respiratory mechanics during the initial 3 days after robotically assisted mitral valve repair.
NCT03743194.
Adults scheduled for robotically assisted mitral valve repairs were randomised to combined pectoralis II and serratus anterior plane blocks or to routine analgesia. The blocks were ultrasound-guided and used a mixture of plain and liposomal bupivacaine. OBAS was measured daily on postoperative Days 1-3 and were analysed with linear mixed effects modelling. Opioid consumption was assessed with a simple linear regression model and respiratory mechanics with a linear mixed model.
As planned, we enrolled 194 patients, with 98 assigned to blocks and 96 to routine analgesic management. There was neither time-by-treatment interaction (P=0.67) nor treatment effect on total OBAS over postoperative Days 1-3 with a median difference of 0.08 (95% confidence interval [CI]: -0.50 to 0.67; P=0.69) and an estimated ratio of geometric means of 0.98 (95% CI: 0.85-1.13; P=0.75). There was no evidence of a treatment effect on cumulative opioid consumption or respiratory mechanics. Average pain scores on each postoperative day were similarly low in both groups.
Serratus anterior and pectoralis plane blocks did not improve postoperative analgesia, cumulative opioid consumption, or respiratory mechanics during the initial 3 days after robotically assisted mitral valve repair.
NCT03743194.
摘要：
背景：微创心脏手术会引起大量疼痛，因此会消耗镇痛药。筋膜平面阻滞对镇痛效果和患者总体满意度的影响尚不清楚。因此，我们测试了主要假设，即筋膜平面阻滞可在机器人辅助二尖瓣修复后的最初3天内改善整体获益镇痛评分（OBAS）。其次，我们检验了阻止减少阿片类药物消耗和改善呼吸力学的假设.
方法：计划进行机器人辅助二尖瓣修复的成年人被随机分配到胸肌II和锯齿肌前平面联合阻滞或常规镇痛。这些块是超声引导的，并使用了普通和脂质体布比卡因的混合物。在术后第1-3天每天测量OBAS,并用线性混合效应建模进行分析。使用简单的线性回归模型评估阿片类药物的消耗，并使用线性混合模型评估呼吸力学。
结果：按计划，我们招募了194名患者，其中98个被分配给阻滞，96个被分配给常规镇痛管理。术后第1-3天对总OBAS既没有治疗时间相互作用（P=0.67），也没有治疗效果，中位差异为0.08（95％置信区间[CI]：-0.50至0.67；P=0.69），几何平均值的估计比为0.98（95％CI：0.85-1.13；P=0.75）。没有证据表明对累积阿片类药物消耗或呼吸力学有治疗作用。两组术后每天的平均疼痛评分相似。
结论：前锯肌和胸肌平面阻滞不能改善术后镇痛效果，累积阿片类药物消费量，或呼吸力学在机器人辅助二尖瓣修复后的最初3天。
背景：NCT03743194。
方法：计划进行机器人辅助二尖瓣修复的成年人被随机分配到胸肌II和锯齿肌前平面联合阻滞或常规镇痛。这些块是超声引导的，并使用了普通和脂质体布比卡因的混合物。在术后第1-3天每天测量OBAS,并用线性混合效应建模进行分析。使用简单的线性回归模型评估阿片类药物的消耗，并使用线性混合模型评估呼吸力学。
结果：按计划，我们招募了194名患者，其中98个被分配给阻滞，96个被分配给常规镇痛管理。术后第1-3天对总OBAS既没有治疗时间相互作用（P=0.67），也没有治疗效果，中位差异为0.08（95％置信区间[CI]：-0.50至0.67；P=0.69），几何平均值的估计比为0.98（95％CI：0.85-1.13；P=0.75）。没有证据表明对累积阿片类药物消耗或呼吸力学有治疗作用。两组术后每天的平均疼痛评分相似。
结论：前锯肌和胸肌平面阻滞不能改善术后镇痛效果，累积阿片类药物消费量，或呼吸力学在机器人辅助二尖瓣修复后的最初3天。
背景：NCT03743194。
