Abstract：
OBJECTIVE: Pain following costal cartilage harvest surgery is the most common complaint of auricular reconstruction (AR). Anesthesiologists are continuously searching for an effective postoperative pain control method.
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.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
摘要：
目的：肋软骨手术后的疼痛是耳廓重建（AR）最常见的主诉。麻醉医师一直在寻找一种有效的术后疼痛控制方法。
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。
方法：本期刊要求作者为每篇文章分配一定程度的证据。对于这些循证医学评级的完整描述，请参阅目录或在线作者说明www。springer.com/00266.
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。
方法：本期刊要求作者为每篇文章分配一定程度的证据。对于这些循证医学评级的完整描述，请参阅目录或在线作者说明www。springer.com/00266.
