PDF(Pubmed)
Abstract：
BACKGROUND: Regional block, such as thoracic epidural analgesia (TEA), thoracic paravertebral block (TPVB), or serratus anterior plane block (SAPB) has been recommended to reduce postoperative opioid use in recent guidelines, but the optimal options for intraoperative opioid minimization remain unclear. The aim of this study was to evaluate the intraoperative opioids-sparing effects of three regional blocks (TEA, TPVB, and SAPB) in patients undergoing video-assisted thoracoscopic surgery (VATs).
METHODS: This was a retrospective study of the adults undergoing VATs at a tertiary medical center between January 2020 and February 2022. According to the type of regional block used, patients were classified into 4 groups: GA group (general anesthesia without any regional block), TEA group (general anesthesia combined with TEA), TPVB group (general anesthesia combined with TPVB), and SAPB group (general anesthesia combined with SAPB). Cases were matched with a 1:1:1:1 ratio for analysis by age, sex, ASA physical status, and operation duration. The primary outcome was the total intraoperative opioid consumption standardized to Oral Morphine Equivalents (OME). Multivariable linear regression was used to estimate the association of the three regional blocks with the OME.
RESULTS: A total of 2159 cases met the eligibility criteria. After matching, 168 cases (42 in each group) were included in analysis. Compared with GA without any reginal block, the use of TEA, TPVB, and SAPB reduced the median of intraoperative OME by 78.45 mg (95% confidence interval [CI], -141.34 to -15.56; P = 0.014), 94.92 mg (95% CI, -154.48 to -35.36; P = 0.020), and 11.47 mg (95% CI, -72.07 to 49.14; P = 0.711), respectively.
CONCLUSIONS: The use of TEA or TPVB was associated with an intraoperative opioid-sparing effect in adults undergoing VATs, whereas the intraoperative opioid-sparing effect of SAPB was not yet clear.
METHODS: This was a retrospective study of the adults undergoing VATs at a tertiary medical center between January 2020 and February 2022. According to the type of regional block used, patients were classified into 4 groups: GA group (general anesthesia without any regional block), TEA group (general anesthesia combined with TEA), TPVB group (general anesthesia combined with TPVB), and SAPB group (general anesthesia combined with SAPB). Cases were matched with a 1:1:1:1 ratio for analysis by age, sex, ASA physical status, and operation duration. The primary outcome was the total intraoperative opioid consumption standardized to Oral Morphine Equivalents (OME). Multivariable linear regression was used to estimate the association of the three regional blocks with the OME.
RESULTS: A total of 2159 cases met the eligibility criteria. After matching, 168 cases (42 in each group) were included in analysis. Compared with GA without any reginal block, the use of TEA, TPVB, and SAPB reduced the median of intraoperative OME by 78.45 mg (95% confidence interval [CI], -141.34 to -15.56; P = 0.014), 94.92 mg (95% CI, -154.48 to -35.36; P = 0.020), and 11.47 mg (95% CI, -72.07 to 49.14; P = 0.711), respectively.
CONCLUSIONS: The use of TEA or TPVB was associated with an intraoperative opioid-sparing effect in adults undergoing VATs, whereas the intraoperative opioid-sparing effect of SAPB was not yet clear.
摘要：
背景：区域块，如胸段硬膜外镇痛（TEA），胸椎旁阻滞（TPVB），或前锯肌平面阻滞（SAPB）在最近的指南中被建议减少术后阿片类药物的使用，但术中阿片类药物最小化的最佳选择仍不清楚.这项研究的目的是评估三种区域阻滞的术中阿片类药物的节制效果（TEA，TPVB,和SAPB）在接受电视胸腔镜手术（VAT）的患者中。
方法：这是对2020年1月至2022年2月在三级医疗中心接受VAT的成年人的回顾性研究。根据使用的区域区块类型，患者分为4组：GA组（全身麻醉，无任何区域阻滞），TEA组(全麻复合TEA),TPVB组(全麻复合TPVB),SAPB组(全麻复合SAPB)。病例以1:1:1:1的比例进行匹配，以按年龄进行分析，性别,ASA物理状态，和操作持续时间。主要结果是术中阿片类药物的总消耗标准化为口服吗啡当量（OME）。使用多变量线性回归来估计三个区域块与OME的关联。
结果：共有2159例符合资格标准。匹配后,168例(每组42例)纳入分析。与没有任何区域块的GA相比，茶的使用，TPVB,SAPB将术中OME的中位数降低了78.45mg（95％置信区间[CI]，-141.34至-15.56；P=0.014），94.92毫克（95%CI，-154.48至-35.36；P=0.020），和11.47毫克（95％CI，-72.07至49.14；P=0.711），分别。
结论：使用TEA或TPVB与术中保留阿片类药物的作用有关，而术中SAPB的阿片类药物保护作用尚不清楚。
方法：这是对2020年1月至2022年2月在三级医疗中心接受VAT的成年人的回顾性研究。根据使用的区域区块类型，患者分为4组：GA组（全身麻醉，无任何区域阻滞），TEA组(全麻复合TEA),TPVB组(全麻复合TPVB),SAPB组(全麻复合SAPB)。病例以1:1:1:1的比例进行匹配，以按年龄进行分析，性别,ASA物理状态，和操作持续时间。主要结果是术中阿片类药物的总消耗标准化为口服吗啡当量（OME）。使用多变量线性回归来估计三个区域块与OME的关联。
结果：共有2159例符合资格标准。匹配后,168例(每组42例)纳入分析。与没有任何区域块的GA相比，茶的使用，TPVB,SAPB将术中OME的中位数降低了78.45mg（95％置信区间[CI]，-141.34至-15.56；P=0.014），94.92毫克（95%CI，-154.48至-35.36；P=0.020），和11.47毫克（95％CI，-72.07至49.14；P=0.711），分别。
结论：使用TEA或TPVB与术中保留阿片类药物的作用有关，而术中SAPB的阿片类药物保护作用尚不清楚。
