Abstract：
OBJECTIVE: This study aimed to compare the analgesic effects of anesthesiologist-administrated erector spinae plane block (ESPB) and surgeon-administrated intercostal nerve block (ICNB) following video-assisted thoracoscopic surgery (VATS).
METHODS: Randomized, controlled, double-blinded study.
METHODS: Operating room, postoperative recovery room and ward in two centers.
METHODS: One hundred patients, ASA I-III and scheduled for elective VATS.
METHODS: The anesthesiologist-administrated ESPB under ultrasound guidance or surgeon-administrated ICNB under video-assisted thoracoscopy was randomly provided during VATS. Regular oral non-opioid analgesic combined with intravenous rescue morphine were prescribed for multimodal analgesia after surgery.
METHODS: The primary outcomes were the pain score and morphine consumption during 48 h after surgery. Postoperative pain intensity were assessed using the 10-cm visual analogue scale at 1 h, 24 h, and 48 h after surgery. Morphine consumption at these time points was compared between the two study groups. Furthermore, oral weak opioid rescue analgesic was also provided at 24 h after surgery. Postoperative quality of recovery at 24 h was also assessed using the QoR-15 questionnaire, along with duration of chest tube drainage and hospital stay were compared as secondary outcomes.
RESULTS: Patients in the two study groups had comparable baseline characteristics, and surgical types were also similar. Postoperative VAS changes at 1 h, 24 h, and 48 h after surgery were also comparable between the two study groups. Both groups had low median scores (<4.0) at all time points (all p > 0.05). Patients in the ESPB group required statistically non-significant higher 48-h morphine consumption [3 (0-6) vs. 0 (0-6) mg in the ESPB group and ICNB group respectively; p = 0.135] and lower numbers of oral rescue analgesic (0.4 ± 1.2 vs. 1.0 ± 1.8 in the ESPB group and ICNB group respectively; p = 0.059). Additionally, patients in the two study groups had similar QoR15 scores and lengths of hospital stay.
CONCLUSIONS: Both anesthesiologist-administered ultrasound-guided ESPB and surgeon-administered VATS ICNB were effective analgesic techniques for patients undergoing VATS for tumor resection.
METHODS: Randomized, controlled, double-blinded study.
METHODS: Operating room, postoperative recovery room and ward in two centers.
METHODS: One hundred patients, ASA I-III and scheduled for elective VATS.
METHODS: The anesthesiologist-administrated ESPB under ultrasound guidance or surgeon-administrated ICNB under video-assisted thoracoscopy was randomly provided during VATS. Regular oral non-opioid analgesic combined with intravenous rescue morphine were prescribed for multimodal analgesia after surgery.
METHODS: The primary outcomes were the pain score and morphine consumption during 48 h after surgery. Postoperative pain intensity were assessed using the 10-cm visual analogue scale at 1 h, 24 h, and 48 h after surgery. Morphine consumption at these time points was compared between the two study groups. Furthermore, oral weak opioid rescue analgesic was also provided at 24 h after surgery. Postoperative quality of recovery at 24 h was also assessed using the QoR-15 questionnaire, along with duration of chest tube drainage and hospital stay were compared as secondary outcomes.
RESULTS: Patients in the two study groups had comparable baseline characteristics, and surgical types were also similar. Postoperative VAS changes at 1 h, 24 h, and 48 h after surgery were also comparable between the two study groups. Both groups had low median scores (<4.0) at all time points (all p > 0.05). Patients in the ESPB group required statistically non-significant higher 48-h morphine consumption [3 (0-6) vs. 0 (0-6) mg in the ESPB group and ICNB group respectively; p = 0.135] and lower numbers of oral rescue analgesic (0.4 ± 1.2 vs. 1.0 ± 1.8 in the ESPB group and ICNB group respectively; p = 0.059). Additionally, patients in the two study groups had similar QoR15 scores and lengths of hospital stay.
CONCLUSIONS: Both anesthesiologist-administered ultrasound-guided ESPB and surgeon-administered VATS ICNB were effective analgesic techniques for patients undergoing VATS for tumor resection.
摘要：
目的：本研究旨在比较电视胸腔镜手术（VATS）后麻醉师给予的竖脊肌平面阻滞（ESPB）和外科医生给予的肋间神经阻滞（ICNB）的镇痛效果。
方法：随机化，控制,双盲研究。
方法：手术室，两个中心的术后恢复室和病房。
方法：一百名患者，ASAI-III，并计划选修VATS。
方法：在VATS期间，随机提供超声引导下麻醉师给予的ESPB或电视胸腔镜下外科医生给予的ICNB。术后常规口服非阿片类镇痛药联合静脉抢救吗啡用于多模式镇痛。
方法：主要结果是术后48小时的疼痛评分和吗啡消耗量。术后1h采用10cm视觉模拟量表评估疼痛强度,24h,术后48小时。比较两个研究组在这些时间点的吗啡消耗。此外，手术后24h还提供口服弱阿片类药物抢救镇痛药。术后24小时恢复质量也使用QoR-15问卷进行评估，作为次要结局,比较了胸管引流时间和住院时间.
结果：两个研究组的患者具有相当的基线特征，手术类型也相似。术后1hVAS变化,24h,和术后48小时也是两个研究组之间的可比性。两组在所有时间点的中位评分均较低（<4.0）（均p>0.05）。ESPB组患者需要48小时吗啡消耗[3（0-6）与ESPB组和ICNB组分别为0（0-6）mg；p=0.135]，口服挽救镇痛药的数量较低（0.4±1.2vs.ESPB组和ICNB组分别为1.0±1.8；p=0.059）。此外,两组患者的QoR15评分和住院时间相似.
结论：麻醉师管理的超声引导的ESPB和外科医生管理的VATSICNB对于接受VATS切除肿瘤的患者都是有效的镇痛技术。
方法：随机化，控制,双盲研究。
方法：手术室，两个中心的术后恢复室和病房。
方法：一百名患者，ASAI-III，并计划选修VATS。
方法：在VATS期间，随机提供超声引导下麻醉师给予的ESPB或电视胸腔镜下外科医生给予的ICNB。术后常规口服非阿片类镇痛药联合静脉抢救吗啡用于多模式镇痛。
方法：主要结果是术后48小时的疼痛评分和吗啡消耗量。术后1h采用10cm视觉模拟量表评估疼痛强度,24h,术后48小时。比较两个研究组在这些时间点的吗啡消耗。此外，手术后24h还提供口服弱阿片类药物抢救镇痛药。术后24小时恢复质量也使用QoR-15问卷进行评估，作为次要结局,比较了胸管引流时间和住院时间.
结果：两个研究组的患者具有相当的基线特征，手术类型也相似。术后1hVAS变化,24h,和术后48小时也是两个研究组之间的可比性。两组在所有时间点的中位评分均较低（<4.0）（均p>0.05）。ESPB组患者需要48小时吗啡消耗[3（0-6）与ESPB组和ICNB组分别为0（0-6）mg；p=0.135]，口服挽救镇痛药的数量较低（0.4±1.2vs.ESPB组和ICNB组分别为1.0±1.8；p=0.059）。此外,两组患者的QoR15评分和住院时间相似.
结论：麻醉师管理的超声引导的ESPB和外科医生管理的VATSICNB对于接受VATS切除肿瘤的患者都是有效的镇痛技术。
