Bilateral erector spinae plane block by multiple injection for pain control in pseudomyxoma peritonei surgery: a single-blind randomized controlled trial.

IF 2.3 3区 医学 Q2 ANESTHESIOLOGY
Shuang Yu, Guangya Gao, Ruiqing Ma, Liangyuan Lu, Yaoping Zhao, Zhanmin Yang
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Abstract

Objective: Currently, the primary surgical treatment for pseudomyxoma peritonei (PMP) is cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC). The perioperative period is frequently accompanied by severe pain. Erector spinae plane block (ESPB) can enhance analgesia for abdominal surgery. The purpose of this study was to compare the analgesic effects of bilateral multiple-injection ESPB in patients with PMP.

Methods: Fifty patients with PMP were randomly divided into two groups: the ESPB combined with general anesthesia group (Group E) and the general anesthesia alone group (Group C). Prior to the induction, patients in Group E underwent ESPB at the T7 and T11 levels. The primary outcome was the visual analog scale (VAS) scores during rest at 6 h post-extubation. Secondary outcomes included intraoperative and postoperative opioid consumption, time for first rescue analgesia, frequency distribution of rescue analgesia, incidence of nausea and vomiting, adverse events associated with ESPB.

Results: The Visual Analogue Scale (VAS) scores in Group E were significantly lower compared to Group C at immediate post-extubation (1.6 ± 0.9 vs. 2.4 ± 1.2, P = 0.008), and at 2 (1.9 ± 1.2 vs. 3.2 ± 1.1, P < 0.001), 4 (2.4 ± 1.5 vs. 3.7 ± 1.0, P = 0.001), and 6 h (2.7 ± 1.1 vs. 3.8 ± 1.4, P = 0.004) post-extubation during rest. Similarly, the VAS scores in Group E were significantly lower than those in Group C at immediate post-extubation (3.0 ± 1.4 vs. 4.6 ± 1.2, P < 0.001), and at 2 (3.8 ± 1.7 vs. 4.9 ± 1.4, P = 0.019), 4 (3.5 ± 1.3 vs. 5.3 ± 1.5, P < 0.001), and 6 h (3.9 ± 1.8 vs. 4.9 ± 1.3, P = 0.004) post-extubation during movement. In Group E, the intraoperative remifentanil administration (2319.3 ± 1089.5 vs. 2984.6 ± 796.1, P = 0.017) and the amount of rescue analgesia within 2 h post-extubation (0 vs. 4, P = 0.037) were significantly less than in Group C, and the first rescue analgesia time was shorter as well (231.4 ± 147.5 vs. 668.8 ± 416.7, P < 0.001).

Conclusion: Compared to general anesthesia alone, bilateral multiple-injection ESPB with 0.2% ropivacaine can enhance analgesia and reduce opioid administration in patients with PMP. However, the duration of analgesia with ESPB is relatively short due to the low concentration of the local anesthetic used.

Trial registration: Chinese Clinical Trial Registry, ChiCTR2300069504, 20/03/2023.

通过多次注射双侧竖脊肌平面阻滞来控制腹膜假性肌瘤手术中的疼痛:单盲随机对照试验。
目的:目前,腹膜假性肌瘤(PMP)的主要手术治疗方法是细胞减灭术(CRS)联合腹腔内热化疗(HIPEC)。围手术期经常伴有剧烈疼痛。脊柱后凸面阻滞(ESPB)可增强腹部手术的镇痛效果。本研究旨在比较双侧多次注射 ESPB 对 PMP 患者的镇痛效果:将 50 名 PMP 患者随机分为两组:ESPB 与全身麻醉联合组(E 组)和单纯全身麻醉组(C 组)。诱导前,E 组患者在 T7 和 T11 水平接受了 ESPB。主要结果是拔管后 6 小时休息时的视觉模拟量表(VAS)评分。次要结果包括术中和术后阿片类药物消耗量、首次镇痛抢救时间、镇痛抢救频率分布、恶心和呕吐发生率、ESPB相关不良事件:拔管后即刻(1.6±0.9 vs. 2.4±1.2,P = 0.008)和拔管后2小时(1.9±1.2 vs. 3.2±1.1,P 结论:与单纯全身麻醉相比,E组的视觉模拟量表(VAS)评分明显低于C组(1.6±0.9 vs. 2.4±1.2,P = 0.008):与单纯全身麻醉相比,双侧多次注射 0.2% 罗哌卡因的 ESPB 可增强 PMP 患者的镇痛效果并减少阿片类药物的用量。然而,由于使用的局麻药浓度较低,ESPB的镇痛持续时间相对较短:试验注册:中国临床试验注册中心,ChiCTR2300069504,20/03/2023。
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
BMC Anesthesiology
BMC Anesthesiology ANESTHESIOLOGY-
CiteScore
3.50
自引率
4.50%
发文量
349
审稿时长
>12 weeks
期刊介绍: BMC Anesthesiology is an open access, peer-reviewed journal that considers articles on all aspects of anesthesiology, critical care, perioperative care and pain management, including clinical and experimental research into anesthetic mechanisms, administration and efficacy, technology and monitoring, and associated economic issues.
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