背景:勃起脊髓平面阻滞(ESPB)是近年来经常使用的胸壁阻滞。目的比较不同体积布比卡因对开胸手术患者ESPB的镇痛效果。
方法:年龄在18至65岁之间的患者,ASAI-III,体重指数(BMI)为18-30kg/m2,正在接受开胸手术的患者被纳入研究。根据镇痛方案,患者被分配到30ml0.25%布比卡因的ESPB(组1)或20ml0.25%布比卡因的ESPB(组2)组。在术后监护室,通过患者自控镇痛泵静脉给予吗啡24h。对乙酰氨基酚1g每8h剂量和右酮洛芬50mg每日2次剂量用于多模式镇痛。
结果:视觉模拟量表(VAS)静息评分,第一(p=0.001),第二(<0.001),第四(<0.001),第8名(<0.001),第16位(<0.010),第24(<0.044),发现20ml组的第48小时(<0.005)-小时VAS静息结果在统计学上显着高于30ml组。20ml组第1天VAS咳嗽评分明显增高(<0.003),第二(<0.001),第四(<0.001),第8名(<0.001),第16位(<0.004),第24(<0.031),和第48(<0.009)小时。吗啡消耗,发现在20ml组中,额外的镇痛药使用在统计学上显着高于30ml组(分别为p<0.001,p=0.001)。两组之间在副作用方面没有统计学上的显着差异(p>0.05)。
结论:开胸患者手术切口前应用ESPB20ml和30ml局部麻醉药的结果表明,使用30ml局部麻醉药可提供更有效的镇痛效果。此外,类似的副作用率表明,30毫升的局部麻醉药可以安全使用。
Erector spinae plane block (ESPB) is a thoracic wall block that has been used frequently in recent years. It was aimed to compare the analgesic efficacy of bupivacaine in different volumes for ESPB in patients undergoing thoracotomy.
Patients who were in the age range of 18 to 65 years, ASA I-III, had a body mass index (BMI) of 18-30 kg/m2 and were undergoing thoracotomy were included in the study. Patients were assigned to ESPB with 30 ml 0.25% bupivacaine (Group-1) or ESPB with 20 ml 0.25% bupivacaine (Group-2) groups according to the analgesia protocol. In the postoperative care unit, intravenous morphine was administered via a patient-controlled analgesia pump for 24 h. A paracetamol dose of 1 g every 8 h and a dexketoprofen dose of 50 mg twice daily were administered iv for multimodal analgesia.
Visual analog scale (VAS) resting scores, the 1st (p = 0.001), 2nd (< 0.001), 4th (< 0.001), 8th (< 0.001), 16th (< 0.010), 24th (< 0.044), and 48th (< 0.005)-hour VAS resting results were found to be statistically significantly higher in the 20 ml group than the 30 ml group. VAS cough scores were statistically significantly higher in the 20 ml group at the 1st (< 0.003), 2nd (< 0.001), 4th (< 0.001), 8th (< 0.001), 16th (< 0.004), 24th (< 0.031), and 48th (< 0.009)-hour. Morphine consumption, and additional analgesic use were found to be statistically significantly higher in the 20 ml group than in the 30 ml group (p < 0.001, p = 0.001, respectively). There was no statistically significant difference between the groups in terms of side effects (p > 0.05).
The results of ESPB applied with 20 ml and 30 ml of local anesthetic before the surgical incision in thoracotomy patients showed that the use of 30 ml of local anesthetic provided more effective analgesia. In addition, similar side-effect rates show that 30 ml of local anesthetic can be used safely.