PDF(Pubmed)
Abstract：
BACKGROUND: We aimed to investigate the effects of intermittent bolus paravertebral block on analgesia and recovery in open hepatectomy.
METHODS: Eighty 18-70 years old, American Society of Anesthesiologists level I-III patients scheduled for hepatectomy with a J-shaped subcostal incision were enrolled and randomized to receive either intermittent bolus paravertebral ropivacaine (0.5% loading, 0.2% infusion) or 0.9% saline infusion at 1:1 ratio (25 ml loading before surgery, 0.125 ml/kg/h bolus for postoperative 48 h). The primary outcome was set as postoperative 48 h cumulative intravenous morphine consumption recorded by a patient-controlled analgesic pump.
RESULTS: Thirty-eight patients in each group completed the study. The cumulative morphine consumptions were lower in the paravertebral block than control group at postoperative 24 (difference -10.5 mg, 95%CI -16 mg to -6 mg, P < 0.001) and 48 (difference -12 mg, 95%CI -19.5 mg to -5 mg, P = 0.001) hours. The pain numerical rating scales at rest were lower in the paravertebral block than control group at postoperative 4 h (difference -2, 95%CI -3 to -1, P < 0.001). The active pain numerical rating scales were lower in the paravertebral block than control group at postoperative 12 h (difference -1, 95%CI -2 to 0, P = 0.005). Three months postoperatively, the paravertebral block group had lower rates of hypoesthesia (OR 0.28, 95%CI 0.11 to 0.75, P = 0.009) and numbness (OR 0.26, 95%CI 0.07 to 0.88, P = 0.024) than the control group.
CONCLUSIONS: Intermittent bolus paravertebral block provided an opioid-sparing effect and enhanced recovery both in hospital and after discharge in patients undergoing hepatectomy.
BACKGROUND: clinicaltrials.gov (NCT04304274), date: 11/03/2020.
METHODS: Eighty 18-70 years old, American Society of Anesthesiologists level I-III patients scheduled for hepatectomy with a J-shaped subcostal incision were enrolled and randomized to receive either intermittent bolus paravertebral ropivacaine (0.5% loading, 0.2% infusion) or 0.9% saline infusion at 1:1 ratio (25 ml loading before surgery, 0.125 ml/kg/h bolus for postoperative 48 h). The primary outcome was set as postoperative 48 h cumulative intravenous morphine consumption recorded by a patient-controlled analgesic pump.
RESULTS: Thirty-eight patients in each group completed the study. The cumulative morphine consumptions were lower in the paravertebral block than control group at postoperative 24 (difference -10.5 mg, 95%CI -16 mg to -6 mg, P < 0.001) and 48 (difference -12 mg, 95%CI -19.5 mg to -5 mg, P = 0.001) hours. The pain numerical rating scales at rest were lower in the paravertebral block than control group at postoperative 4 h (difference -2, 95%CI -3 to -1, P < 0.001). The active pain numerical rating scales were lower in the paravertebral block than control group at postoperative 12 h (difference -1, 95%CI -2 to 0, P = 0.005). Three months postoperatively, the paravertebral block group had lower rates of hypoesthesia (OR 0.28, 95%CI 0.11 to 0.75, P = 0.009) and numbness (OR 0.26, 95%CI 0.07 to 0.88, P = 0.024) than the control group.
CONCLUSIONS: Intermittent bolus paravertebral block provided an opioid-sparing effect and enhanced recovery both in hospital and after discharge in patients undergoing hepatectomy.
BACKGROUND: clinicaltrials.gov (NCT04304274), date: 11/03/2020.
摘要：
背景：我们旨在研究间歇性椎旁推注阻滞对开腹肝切除术镇痛和恢复的影响。
方法：80岁18-70岁，美国麻醉医师协会I-III级患者计划采用J形肋下切口进行肝切除术，并随机接受间歇性推注椎旁罗哌卡因（0.5％负荷，0.2％的输注）或0.9％的生理盐水以1：1的比例输注（手术前25毫升装载，术后48h推注0.125ml/kg/h）。主要结果设定为患者控制的镇痛泵记录的术后48小时累积静脉吗啡消耗量。
结果：每组38名患者完成了研究。术后24时椎旁阻滞的累积吗啡消耗量低于对照组（差异-10.5mg，95CI-16mg至-6mg，P<0.001）和48（差异-12毫克，95CI-19.5mg至-5mg，P=0.001）小时。椎旁阻滞术后4h静息时疼痛评分低于对照组(差异2,95CI-3~-1,P<0.001)。术后12h，椎旁阻滞组的主动疼痛评分低于对照组（差异-1，95CI-2至0，P=0.005）。术后三个月,椎旁阻滞组的感觉减退率(OR0.28,95CI0.11~0.75,P=0.009)和麻木率(OR0.26,95CI0.07~0.88,P=0.024)低于对照组.
结论：间歇性椎旁推注阻滞在接受肝切除术的患者中提供了保留阿片类药物的效果，并增强了患者在医院和出院后的恢复。
背景：clinicaltrials.gov（NCT04304274），日期：2020年3月11日。
方法：80岁18-70岁，美国麻醉医师协会I-III级患者计划采用J形肋下切口进行肝切除术，并随机接受间歇性推注椎旁罗哌卡因（0.5％负荷，0.2％的输注）或0.9％的生理盐水以1：1的比例输注（手术前25毫升装载，术后48h推注0.125ml/kg/h）。主要结果设定为患者控制的镇痛泵记录的术后48小时累积静脉吗啡消耗量。
结果：每组38名患者完成了研究。术后24时椎旁阻滞的累积吗啡消耗量低于对照组（差异-10.5mg，95CI-16mg至-6mg，P<0.001）和48（差异-12毫克，95CI-19.5mg至-5mg，P=0.001）小时。椎旁阻滞术后4h静息时疼痛评分低于对照组(差异2,95CI-3~-1,P<0.001)。术后12h，椎旁阻滞组的主动疼痛评分低于对照组（差异-1，95CI-2至0，P=0.005）。术后三个月,椎旁阻滞组的感觉减退率(OR0.28,95CI0.11~0.75,P=0.009)和麻木率(OR0.26,95CI0.07~0.88,P=0.024)低于对照组.
结论：间歇性椎旁推注阻滞在接受肝切除术的患者中提供了保留阿片类药物的效果，并增强了患者在医院和出院后的恢复。
背景：clinicaltrials.gov（NCT04304274），日期：2020年3月11日。
