Erector spinae plane versus paravertebral versus multiple intercostal nerve blocks in patients undergoing vats; A randomized controlled trial

Q2 Nursing

Perioperative Care and Operating Room Management Pub Date : 2024-06-01 DOI:10.1016/j.pcorm.2024.100409

Mona Mohamed Mogahed , Mohamed Samir Abd El-ghaffar , Taha Saad Al Noamani , Mohamed Shafik Elkahwagy

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引用次数: 0

Abstract

Background

Video-assisted thoracoscopic surgery (VATS) is a minimally invasive technique with shorter recovery times and lesser postoperative pain than open thoracotomies. Regional blocks decrease the anesthetic and postoperative analgesic requirements.

Methods

105 patients scheduled for VATS under general anesthesia were included. Patients were randomly allocated to receive 20 ml of bupivacaine 0.5 % mixed with adrenaline 2 mcg/ml by ultrasound-guided erector spinae plane block (ESPB) at T5 level (Group ESPB, n = 35), 20 ml of bupivacaine 0.5 % mixed with adrenaline 2 mcg/ml by paravertebral block (PVB) at T5 level (Group PVB, n = 35), or multiple intercostal nerve blocks (Group MICNB, n = 35) where 2–3 ml of bupivacaine 0.5 % mixed with adrenaline 2 mcg/ml for each intercostal space from the third to the eighth intercostal nerve were injected by the surgeon through the thoracoscope. The objectives of this study were primarily to assess the effectiveness of the erector spinae plane versus paravertebral versus multiple intercostal nerve blocks on the intraoperative patient anesthetic requirements and secondarily to assess the postoperative analgesic requirements.

Results

No significant differences were observed regarding End tidal Sevoflurane (Et Sevo) all over the operative time between the ESPB and the PVB group; however there were highly significant differences between either group and the MICNB group immediately after induction of anesthesia till 60 min later, No significant difference between ESPB and the PVB groups as regards to the total amount of intraoperative fentanyl consumption, on the other hand there were highly significant difference between the ESPB or the PVB group and the MICNB group; while all the three groups provide comparable postoperative analgesia with non-significant difference regarding the postoperative VAS either during rest or cough.

Conclusion

ESPB and PVB provided better intraoperative anesthetic sparing effect than MICNB; however all the three blocks provide comparable postoperative analgesia either during rest or during cough in patients undergoing VATS.

查看原文本刊更多论文

对接受静脉输液的患者进行脊柱后凸平面与椎旁与多根肋间神经阻滞的随机对照试验

背景视频辅助胸腔镜手术（VATS）是一种微创技术，与开胸手术相比，其恢复时间更短，术后疼痛更轻。方法纳入了 105 名计划在全身麻醉下进行 VATS 手术的患者。患者被随机分配接受 20 毫升 0.5 % 布比卡因混合 2 毫克/毫升肾上腺素在 T5 水平通过超声引导竖脊平面阻滞（ESPB）（ESPB 组，n = 35）、20 毫升 0.5 %布比卡因与肾上腺素 2 mcg/ml 混合，在 T5 水平进行椎旁阻滞 (PVB)（PVB 组，n = 35），或多肋间神经阻滞（MICNB 组，n = 35），由外科医生通过胸腔镜为从第三至第八肋间神经的每个肋间隙注射 2-3 ml 0.5 %布比卡因与肾上腺素 2 mcg/ml 混合。本研究的主要目的是评估竖脊肌平面与椎旁与多根肋间神经阻滞对术中患者麻醉需求的有效性，其次是评估术后镇痛需求。结果在整个手术时间内，ESPB 组和 PVB 组在潮气量七氟醚（Et Sevo）方面没有观察到明显差异；但在麻醉诱导后立即到 60 分钟后，ESPB 组和 PVB 组与 MICNB 组之间存在高度显著差异；而所有三组的术后镇痛效果相当，术后休息或咳嗽时的 VAS 均无显著差异。结论ESPB 和 PVB 比 MICNB 具有更好的术中麻药稀释效果；但在接受 VATS 手术的患者中，三组阻滞在术后休息或咳嗽时提供的镇痛效果相当。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Perioperative Care and Operating Room Management Nursing-Medical and Surgical Nursing

CiteScore

1.30

自引率

0.00%

发文量

审稿时长

56 days

期刊介绍： The objective of this new online journal is to serve as a multidisciplinary, peer-reviewed source of information related to the administrative, economic, operational, safety, and quality aspects of the ambulatory and in-patient operating room and interventional procedural processes. The journal will provide high-quality information and research findings on operational and system-based approaches to ensure safe, coordinated, and high-value periprocedural care. With the current focus on value in health care it is essential that there is a venue for researchers to publish articles on quality improvement process initiatives, process flow modeling, information management, efficient design, cost improvement, use of novel technologies, and management.