背景:胸骨旁肋间阻滞(PSB)已被提议用于正中胸骨切开术患者的术后镇痛。PSB可以使用两种不同的方法来实现,分别为浅表胸骨旁肋间平面阻滞(SPIP)和深胸骨旁肋间平面阻滞(DPIP)。
方法:我们设计了当前的前瞻性,观察性队列研究,比较两种方法的镇痛效果。选择2022年1月至9月接受全胸骨切开术的心脏外科手术患者,分为三组,根据疼痛控制策略:吗啡,SPIP,和DPIP组。主要结果是术后疼痛评估为12h的NRS绝对值。次要结果是24和48h的NRS,需要挽救镇痛(阿片类药物和NSAIDs),术后恶心和呕吐的发生率,拔管时间,机械通气持续时间,和肠功能障碍。
结果:共纳入96人。研究组之间在24小时和48小时的中值数字疼痛评定量表方面没有显着差异。术后吗啡总消耗量为1.00(0.00-3.00),2.00(0.00-5.50),和15.60毫克(9.60-30.00)在SPIP,DPIP,还有吗啡组,分别(SPIP和DPIP与吗啡:p<0.001)。与吗啡组相比,SPIP和DPIP组的甲氧氯普胺消耗量较低(p=0.01)。研究组之间的机械通气持续时间和肠道活动没有差异。DPIP组发生两次气胸。
结论:SPIP和DPIP似乎都能够通过全正中胸骨切开术保证心脏手术后阶段的有效疼痛管理,同时确保减少阿片类药物和止吐药物的消耗。
BACKGROUND: Parasternal intercostal blocks (PSB) have been proposed for postoperative analgesia in patients undergoing median sternotomy. PSB can be achieved using two different approaches, the superficial parasternal intercostal plane block (SPIP) and deep parasternal intercostal plane block (DPIP) respectively.
METHODS: We designed the present prospective, observational cohort study to compare the analgesic efficacy of the two approaches. Cardiac surgical patients who underwent full sternotomy from January to September 2022 were enrolled and divided into three groups, according to pain control strategy: morphine, SPIP, and DPIP group. Primary outcomes were was postoperative pain evaluated as absolute value of NRS at 12 h. Secondary outcomes were the NRS at 24 and 48 h, the need for salvage analgesia (both opioids and NSAIDs), incidence of postoperative nausea and vomiting, time to extubation, mechanical ventilation duration, and bowel disfunction.
RESULTS: Ninety-six were enrolled. There was no significant difference in terms of median Numeric Pain Rating Scale at 24 h and at 48 h between the study groups. Total postoperative morphine consumption was 1.00 (0.00-3.00), 2.00 (0.00-5.50), and 15.60 mg (9.60-30.00) in the SPIP, DPIP, and morphine group, respectively (SPIP and DPIP vs morphine: p < 0.001). Metoclopramide consumption was lower in SPIP and DPIP group compared with morphine group (p = 0.01). There was no difference in terms of duration of mechanical ventilation and of bowel activity between the study groups. Two pneumothorax occurred in the DPIP group.
CONCLUSIONS: Both SPIP and DPIP seem able to guarantee an effective pain management in the postoperative phase of cardiac surgeries via full median sternotomy while ensuring a reduced consumption of opioids and antiemetic drugs.