METHODS: This study was conducted from 10 April 2022 to 10 June 2022. Sixty children undergoing AR using costal cartilage were randomly assigned to either a serratus anterior plane block performed before costal cartilage harvest (SAPB-pre-cohort; n = 30) or the SAPB-post-cohort (Post-costal cartilage Harvest Cohort: n = 30). The primary endpoint measures were the Numerical Rating Scale (NRS) scores of the chest and ear pain degrees recorded at 1-, 6-, 12-, 24-, and 48-h after surgery. Intraoperative anesthetic and analgesic dosages, sufentanil consumption and rescue analgesia consumption during the first 24 h post-operation, cough score during extubation, extubation agitation score, length of stay, the extubation time, first ambulatory time, analgesia duration, and opioid-related adverse effects and SAPB-related adverse effects were the secondary endpoints.
RESULTS: The rest and coughing NRS scores were significantly reduced in the SAPB-pre-cohort 6 and 12 h post-operation in comparison with the SAPB-post-cohort (rest 6 h p = 0.002, others p < 0.001). No significant difference in the NRS ear scores existed between the two cohorts (p > 0.05). The use of propofol and remifentanil for general anesthesia during the SAPB-pre-procedure was significantly reduced compared to the SAPB-post-group, with statistical significance (p < 0.001). Sufentanil consumption and rescue analgesia consumption were significantly reduced in the SAPB-pre-cohort (p = 0.001, p = 0.033). The extubation time and first ambulatory time were markedly shorter in the SAPB-pre-cohort (all p < 0.001). Analgesia duration was markedly longer in the SAPB-pre-cohort (p < 0.001). No significant differences were noted in the cough score during extubation, extubation agitation score, length of stay between the two cohorts (all p > 0.05). Opioid-related adverse effects occurred more in the SAPB-post-cohort, while there was no statistical significance (16.7 vs. 36.7%; p = 0.082). There were no blockade-related complications observed in either cohort.
CONCLUSIONS: The analgesic effect of the SAPB-pre-cohort was better than the SAPB-post-cohort suggesting both efficacy and feasibility of preemptive analgesia.
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方法:本研究于2022年4月10日至2022年6月10日进行。60名使用肋软骨接受AR的儿童被随机分配到肋软骨收获前进行的锯肌前平面阻滞(SAPB前队列;n=30)或SAPB后队列(肋软骨收获后队列:n=30)。主要终点指标是记录在1-,6-,12-,24-,和手术后48小时。术中麻醉和镇痛剂量,术后头24h舒芬太尼消耗量和抢救镇痛消耗量,拔管时咳嗽评分,拔管躁动评分,逗留时间,拔管时间,第一次住院时间,镇痛持续时间,阿片类药物相关不良反应和SAPB相关不良反应是次要终点.
结果:与SAPB后队列相比,SAPB前队列术后6和12小时的休息和咳嗽NRS评分显着降低(休息6小时p=0.002,其他p<0.001)。两组NRSear评分差异无统计学意义(p>0.05)。与SAPB-post组相比,在SAPB-pre-procedure期间用于全身麻醉的丙泊酚和瑞芬太尼的使用显著减少,具有统计学意义(p<0.001)。SAPB前队列中的舒芬太尼消耗量和抢救镇痛消耗量显着降低(p=0.001,p=0.033)。SAPB前队列中的拔管时间和首次住院时间明显较短(均p<0.001)。SAPB前队列中的镇痛持续时间明显更长(p<0.001)。拔管期间咳嗽评分无显著差异,拔管躁动评分,两组之间的住院时间(均p>0.05)。阿片类药物相关的不良反应发生在SAPB后队列中更多,而没有统计学意义(16.7vs.36.7%;p=0.082)。在任一队列中均未观察到与阻断相关的并发症。
结论:SAPB前队列的镇痛效果优于SAPB后队列,表明超前镇痛的有效性和可行性。
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