PDF(Pubmed)
Abstract：
OBJECTIVE: Opioid-free anesthesia with erector spinae plane block (ESPB) has the potential to decrease perioperative opioid need, thereby potentially reducing related complications. This study aimed to compare opioid-free anesthesia with ESPB and standard opioid-based balanced anesthesia in patients undergoing video-assisted thoracic surgery (VATS) in terms of postoperative opioid need (through patient control analgesia) as well as postoperative pain management, recovery quality, and opioid-related side effects.
METHODS: Seventy-four patients, ranging in age from 18 to 75 years, who underwent lobectomy with VATS were included in this randomized-controlled study. The opioid-free group had ESPB, and no opioid was used during anesthesia maintenance. The opioid group received standard anesthesia with opioid use. Postoperative morphine requirement, postoperative pain as measured by the visual analog scale (VAS), intraoperative vital parameters, recovery quality using the Quality of Recovery-40 (QoR-40) questionnaire, and opioid-related complications were compared between groups.
RESULTS: The opioid-free group received a significantly lower total dose of morphine during the first 24 postoperative hours through patient-controlled analgesia (PCA) when compared to the opioid group (7.3±3.4 vs. 21.7±7.9 mg, p<0.001). In addition, the opioid-free group had significantly better postoperative pain scores and QoR-40 scores (184.3±7.5 versus 171.2±6.4, p<0.001), shorter times to mobilization (5.5±0.8 versus 8.1±1.1 hours, p<0.001), and oral intake (5.8±0.6 versus 6.4±0.6 hours, p<0.001), as well as less frequent opioid-related side effects.
CONCLUSIONS: The findings of this study suggest that opioid-free anesthesia with ESPB represents a promising option for patients undergoing lobectomy with VATS. It has the potential to decrease postoperative opioid need, improve postoperative pain management, and reduce opioid-related unwanted consequences.
METHODS: Seventy-four patients, ranging in age from 18 to 75 years, who underwent lobectomy with VATS were included in this randomized-controlled study. The opioid-free group had ESPB, and no opioid was used during anesthesia maintenance. The opioid group received standard anesthesia with opioid use. Postoperative morphine requirement, postoperative pain as measured by the visual analog scale (VAS), intraoperative vital parameters, recovery quality using the Quality of Recovery-40 (QoR-40) questionnaire, and opioid-related complications were compared between groups.
RESULTS: The opioid-free group received a significantly lower total dose of morphine during the first 24 postoperative hours through patient-controlled analgesia (PCA) when compared to the opioid group (7.3±3.4 vs. 21.7±7.9 mg, p<0.001). In addition, the opioid-free group had significantly better postoperative pain scores and QoR-40 scores (184.3±7.5 versus 171.2±6.4, p<0.001), shorter times to mobilization (5.5±0.8 versus 8.1±1.1 hours, p<0.001), and oral intake (5.8±0.6 versus 6.4±0.6 hours, p<0.001), as well as less frequent opioid-related side effects.
CONCLUSIONS: The findings of this study suggest that opioid-free anesthesia with ESPB represents a promising option for patients undergoing lobectomy with VATS. It has the potential to decrease postoperative opioid need, improve postoperative pain management, and reduce opioid-related unwanted consequences.
摘要：
目的：无阿片类麻醉与竖脊肌平面阻滞（ESPB）有可能减少围手术期阿片类药物的需求，从而潜在地减少相关并发症。这项研究旨在比较无阿片类药物麻醉与ESPB和标准阿片类药物平衡麻醉在接受电视胸外科手术（VATS）的患者术后阿片类药物需求（通过患者控制镇痛）以及术后疼痛管理。恢复质量，和阿片类药物相关的副作用。
方法：74名患者，年龄从18岁到75岁，接受VATS肺叶切除术的患者被纳入这项随机对照研究.无阿片类药物组患有ESPB，麻醉维持期间未使用阿片类药物。阿片类药物组使用阿片类药物接受标准麻醉。术后吗啡需求,通过视觉模拟量表（VAS）测量的术后疼痛，术中重要参数，使用回收质量-40(QoR-40)问卷的回收质量，比较两组患者的阿片类药物相关并发症。
结果：与阿片类药物组相比，无阿片类药物组通过患者自控镇痛（PCA）在术后24小时内接受吗啡总剂量显着降低（7.3±3.4vs.21.7±7.9毫克，p<0.001)。此外,无阿片类药物组术后疼痛评分和QoR-40评分明显更好(184.3±7.5vs171.2±6.4,p<0.001),动员时间较短(5.5±0.8对8.1±1.1小时，p<0.001)，和口服摄入量（5.8±0.6对6.4±0.6小时，p<0.001)，以及较不常见的阿片类药物相关副作用。
结论：这项研究的结果表明，对于接受VATS肺叶切除术的患者，无阿片类药物的ESPB麻醉是一种有希望的选择。它有可能减少术后阿片类药物的需求，改善术后疼痛管理，并减少与阿片类药物相关的不良后果。
方法：74名患者，年龄从18岁到75岁，接受VATS肺叶切除术的患者被纳入这项随机对照研究.无阿片类药物组患有ESPB，麻醉维持期间未使用阿片类药物。阿片类药物组使用阿片类药物接受标准麻醉。术后吗啡需求,通过视觉模拟量表（VAS）测量的术后疼痛，术中重要参数，使用回收质量-40(QoR-40)问卷的回收质量，比较两组患者的阿片类药物相关并发症。
结果：与阿片类药物组相比，无阿片类药物组通过患者自控镇痛（PCA）在术后24小时内接受吗啡总剂量显着降低（7.3±3.4vs.21.7±7.9毫克，p<0.001)。此外,无阿片类药物组术后疼痛评分和QoR-40评分明显更好(184.3±7.5vs171.2±6.4,p<0.001),动员时间较短(5.5±0.8对8.1±1.1小时，p<0.001)，和口服摄入量（5.8±0.6对6.4±0.6小时，p<0.001)，以及较不常见的阿片类药物相关副作用。
结论：这项研究的结果表明，对于接受VATS肺叶切除术的患者，无阿片类药物的ESPB麻醉是一种有希望的选择。它有可能减少术后阿片类药物的需求，改善术后疼痛管理，并减少与阿片类药物相关的不良后果。
