PDF(Pubmed)
Abstract：
BACKGROUND: Regional analgesia techniques are crucial for pain management after cervical spine surgeries. Anesthesiologists strive to select the most effective and least hazardous regional analgesia technique for the cervical region. Our hypothesis is that an intermediate cervical plexus (IC) block can provide adequate postoperative analgesia compared to a cervical erector spinae (ES) block in patients undergoing anterior cervical spine surgery.
METHODS: In this double-blind prospective trial, 58 patients were randomly assigned into two equal groups prior to the administration of general anesthesia. Patients in the IC group (n = 29) underwent ultrasound-guided bilateral intermediate cervical plexus block with 15 ml of bupivacaine 0.25% administered to each side. The ES group (n = 29) underwent ultrasound-guided bilateral cervical erector spinae plane blocks with 15 ml of 0.25% bupivacaine administered to each side at the C6 level. The primary outcome was to record the time to the first call for rescue analgesia (nalbuphine), and the secondary outcomes were to measure the performance time, the onset of the sensory block, the intraoperative fentanyl consumption, postoperative pain intensity using VAS, the postoperative total nalbuphine consumption, and postoperative complications such as nausea, vomiting, hypotension, and bradycardia.
RESULTS: The performance and onset of sensory block times were significantly shorter in the IC group compared to the ES group. The time to first call for nalbuphine was significantly shorter in the IC group (7.31 ± 1.34 h) compared to the ES group (11.10 ± 1.82 h). The mean postoperative VAS scores were comparable between the two groups at the measured time points, except at 8 h, where it was significantly higher in the IC group, and at 12 h, where it was significantly higher in the ES group. The total nalbuphine consumption was significantly higher in the IC group (33.1 ± 10.13 mg) compared to the ES group (22.76 ± 8.62 mg).
CONCLUSIONS: For patients undergoing anterior cervical spine surgery, the intermediate cervical plexus block does not provide better postoperative regional analgesia compared to the cervical erector spinae block. Performance time and onset time were shorter in the IC group, whereas nalbuphine consumption was lower in the ES group.
BACKGROUND: The trial was registered at clinicaltrials.gov. (NCT05577559, and the date of registration: 13-10-2022).
METHODS: In this double-blind prospective trial, 58 patients were randomly assigned into two equal groups prior to the administration of general anesthesia. Patients in the IC group (n = 29) underwent ultrasound-guided bilateral intermediate cervical plexus block with 15 ml of bupivacaine 0.25% administered to each side. The ES group (n = 29) underwent ultrasound-guided bilateral cervical erector spinae plane blocks with 15 ml of 0.25% bupivacaine administered to each side at the C6 level. The primary outcome was to record the time to the first call for rescue analgesia (nalbuphine), and the secondary outcomes were to measure the performance time, the onset of the sensory block, the intraoperative fentanyl consumption, postoperative pain intensity using VAS, the postoperative total nalbuphine consumption, and postoperative complications such as nausea, vomiting, hypotension, and bradycardia.
RESULTS: The performance and onset of sensory block times were significantly shorter in the IC group compared to the ES group. The time to first call for nalbuphine was significantly shorter in the IC group (7.31 ± 1.34 h) compared to the ES group (11.10 ± 1.82 h). The mean postoperative VAS scores were comparable between the two groups at the measured time points, except at 8 h, where it was significantly higher in the IC group, and at 12 h, where it was significantly higher in the ES group. The total nalbuphine consumption was significantly higher in the IC group (33.1 ± 10.13 mg) compared to the ES group (22.76 ± 8.62 mg).
CONCLUSIONS: For patients undergoing anterior cervical spine surgery, the intermediate cervical plexus block does not provide better postoperative regional analgesia compared to the cervical erector spinae block. Performance time and onset time were shorter in the IC group, whereas nalbuphine consumption was lower in the ES group.
BACKGROUND: The trial was registered at clinicaltrials.gov. (NCT05577559, and the date of registration: 13-10-2022).
摘要：
背景：局部镇痛技术对于颈椎手术后的疼痛管理至关重要。麻醉师努力为宫颈区域选择最有效和最不危险的区域镇痛技术。我们的假设是，与接受颈椎前路手术的患者相比，中间颈丛（IC）阻滞可以提供足够的术后镇痛。
方法：在这项双盲前瞻性试验中，在全身麻醉之前，将58例患者随机分为两个相等的组。IC组（n=29）的患者接受了超声引导的双侧中间颈丛阻滞，每侧给予15ml0.25％的布比卡因。ES组（n=29）接受了超声引导的双侧宫颈竖脊肌平面阻滞，在C6水平的两侧分别给予15ml0.25％布比卡因。主要结果是记录到第一次呼叫抢救镇痛（纳布啡）的时间，次要结果是衡量绩效时间，感觉阻滞的开始，术中芬太尼的消耗，使用VAS的术后疼痛强度，术后纳布啡的总消耗量，术后并发症如恶心，呕吐,低血压,和心动过缓.
结果：与ES组相比，IC组的表现和感觉阻滞开始时间明显缩短。与ES组（11.10±1.82h）相比，IC组首次调用纳布啡的时间（7.31±1.34h）明显缩短。两组在测量时间点的平均术后VAS评分具有可比性，除了在8小时，在IC组中明显更高，在12小时，在ES组中明显更高。IC组纳布啡的总消耗量（33.1±10.13mg）明显高于ES组（22.76±8.62mg）。
结论：对于接受颈椎前路手术的患者，中间颈丛阻滞与颈勃起脊髓阻滞相比，不能提供更好的术后区域镇痛。IC组的表现时间和起效时间较短，而ES组的纳布啡消费量较低。
背景：该试验已在clinicaltrials.gov注册。（NCT05577559，注册日期：13-10-2022）。
方法：在这项双盲前瞻性试验中，在全身麻醉之前，将58例患者随机分为两个相等的组。IC组（n=29）的患者接受了超声引导的双侧中间颈丛阻滞，每侧给予15ml0.25％的布比卡因。ES组（n=29）接受了超声引导的双侧宫颈竖脊肌平面阻滞，在C6水平的两侧分别给予15ml0.25％布比卡因。主要结果是记录到第一次呼叫抢救镇痛（纳布啡）的时间，次要结果是衡量绩效时间，感觉阻滞的开始，术中芬太尼的消耗，使用VAS的术后疼痛强度，术后纳布啡的总消耗量，术后并发症如恶心，呕吐,低血压,和心动过缓.
结果：与ES组相比，IC组的表现和感觉阻滞开始时间明显缩短。与ES组（11.10±1.82h）相比，IC组首次调用纳布啡的时间（7.31±1.34h）明显缩短。两组在测量时间点的平均术后VAS评分具有可比性，除了在8小时，在IC组中明显更高，在12小时，在ES组中明显更高。IC组纳布啡的总消耗量（33.1±10.13mg）明显高于ES组（22.76±8.62mg）。
结论：对于接受颈椎前路手术的患者，中间颈丛阻滞与颈勃起脊髓阻滞相比，不能提供更好的术后区域镇痛。IC组的表现时间和起效时间较短，而ES组的纳布啡消费量较低。
背景：该试验已在clinicaltrials.gov注册。（NCT05577559，注册日期：13-10-2022）。
