PDF(Pubmed)
Abstract：
Regional anesthesia in postoperative pain management has developed in recent years, especially with the advent of fascial plane blocks. This study aims to compare the ultrasound-guided bilateral erector spinae plane block (ESPB) versus the ultrasound-guided bilateral transversus abdominis plane block (TAPB) on postoperative analgesia after laparoscopic or robotic urologic surgery. This was a prospective observational study; 97 patients (ESPB-group) received bilateral ultrasound-guided ESPB with 20 mL of ropivacaine 0.375% plus 0.5 mcg/kg of dexmedetomidine in each side at the level of T7-T9 and 93 patients (TAPB-group) received bilateral ultrasound-guided TAPB with 20 mL ropivacaine 0.375% or 0.25%. The primary outcome was the postoperative numeric rating scale (NRS) pain score, which was significantly lower in the ESPB group on postoperative days 0, 1, 2, and 3 (p < 0.001) and, consequently, the number of patients requiring postoperative supplemental analgesic rescue therapies was significantly lower (p < 0.001). Concerning the secondary outcomes, consumption of ropivacaine was significantly lower in the group (p < 0.001) and the total amount of analgesic rescue doses was significantly lower in the ESPB-group than the TAPB-group in postoperative days from 2 to 4 (1 vs. 3, p > 0.001). Incidence of postoperative nausea and vomiting was higher in the TAPB group and no block-related complications were observed. Our data indicate that ESPB provides postoperative pain control at least as good as TAPB plus morphine, with less local anesthetic needed.
摘要：
区域麻醉在术后疼痛管理中的应用是近年来发展起来的,特别是随着筋膜平面块的出现。这项研究旨在比较超声引导的双侧竖脊肌平面阻滞（ESPB）与超声引导的双侧腹横肌平面阻滞（TAPB）在腹腔镜或机器人泌尿外科手术后的术后镇痛效果。这是一项前瞻性观察性研究；97例患者（ESPB组）在T7-T9水平下接受双侧超声引导的ESPB，每侧20mL罗哌卡因0.375％加0.5mcg/kg右美托咪定，93例患者（TAPB组）接受双侧超声引导的TAPB，20mL罗哌卡因0.375％或0.25％。主要结果是术后数字评定量表（NRS）疼痛评分，在术后第0、1、2和3天，ESPB组显著降低（p<0.001），因此,需要术后辅助镇痛抢救治疗的患者数量显著减少(p<0.001).关于次要结果，在术后2至4天，该组中罗哌卡因的消耗量显着降低（p<0.001），并且ESPB组的镇痛抢救剂量总量显着低于TAPB组（1vs.3，p>0.001)。TAPB组术后恶心和呕吐的发生率较高，未观察到与阻塞相关的并发症。我们的数据表明，ESPB提供的术后疼痛控制至少与TAPB加吗啡一样好，需要更少的局部麻醉剂。
