超声引导下的竖脊平面阻滞与胸硬膜外阻滞用于小儿努斯手术术后镇痛:随机非劣效性试验。

IF 2.8 3区 医学 Q2 ANESTHESIOLOGY
Journal of Anesthesia Pub Date : 2024-10-01 Epub Date: 2024-06-03 DOI:10.1007/s00540-024-03354-0
Yi Ren, Xiaolu Nie, Fuzhou Zhang, Yangwei Ma, Lei Hua, Tiehua Zheng, Zenghua Xu, Jia Gao, Jianmin Zhang
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引用次数: 0

摘要

目的:胸部硬膜外麻醉(TEA)通常用于胸部手术后的镇痛。有人提出脊柱后凸面阻滞(ESPB)可提供充分的镇痛。我们假设,在接受努斯手术的小儿患者中,ESPB作为多模式镇痛的一部分,其效果不会劣于TEA:方法:年龄在 7-18 岁、计划接受努斯手术的患者被随机分配到接受双侧单针 ESPB 或 TEA 以及包括家长控制静脉镇痛 (PCIA) 在内的多模式镇痛方案。术后6小时、12小时、18小时和24小时,使用数字评分量表(NRS)对疼痛进行评估,并通过计算PCIA栓剂的数量来评估阿片类药物的消耗量。联合主要结果是术后 24 小时的平均疼痛评分和阿片类药物消耗量。次要结果为术后不同时间点的 NRS 评分和阿片类药物用量、不良事件和恢复质量:300名患者接受了随机分组,其中286人接受了ESPB(147人)或TEA(139人)治疗。术后24小时,ESPB的平均NRS评分不劣于TEA(平均差异为-0.1,95%置信区间[CI]为-0.3-0.1,差值=1,P为非劣性):研究结果表明,在接受努斯手术的儿科患者中,ESPB与多模式镇痛相结合,在疼痛评分和阿片类药物用量方面的镇痛效果不劣于TEA。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Ultrasound-guided erector spinae plane block versus thoracic epidural block for postoperative analgesia in pediatric Nuss surgery: a randomized noninferiority trial.

Ultrasound-guided erector spinae plane block versus thoracic epidural block for postoperative analgesia in pediatric Nuss surgery: a randomized noninferiority trial.

Purpose: Thoracic epidural anesthesia (TEA) is often used for analgesia after thoracic surgery. Erector spinae plane block (ESPB) has been proposed to provide adequate analgesia. We hypothesized that ESPB would be noninferior to TEA as a part of multimodal analgesia in pediatric patients undergoing the Nuss procedure.

Methods: Patients aged 7-18 years and scheduled for the Nuss procedure were randomly allocated to receive bilateral single-shot ESPB or TEA and a multimodal analgesic regimen including parent-controlled intravenous analgesia (PCIA). At 6 h, 12 h, 18 h, and 24 h postoperatively, pain was evaluated using the numeric rating scale (NRS) and opioid consumption was assessed by counting the number of PCIA boluses. The joint primary outcomes were the average pain score and opioid consumption at 24 h after surgery. The secondary outcomes were the NRS scores and the number of opioid boluses administered at different postoperative time points, adverse events, and recovery quality.

Results: Three hundred patients underwent randomization, and 286 received ESPB (147 patients) or TEA (139 patients). At 24 h postoperatively, ESPB was noninferior to TEA in terms of the average NRS score (mean difference, - 0.1, 95% confidence interval [CI], - 0.3-0.1, margin = 1, P for noninferiority < 0.001) and the number of opioid boluses administered (mean difference, - 1.1, 95% CI, - 2.8-0.6, margin = 7, P for noninferiority < 0.001). Adverse events and patient recovery were comparable between groups.

Conclusions: The results demonstrate that combined with a multimodal analgesia, ESPB provides noninferior analgesia compared to TEA with respect to pain score and opioid consumption among pediatric patients undergoing the Nuss procedure.

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来源期刊
Journal of Anesthesia
Journal of Anesthesia 医学-麻醉学
CiteScore
5.30
自引率
7.10%
发文量
112
审稿时长
3-8 weeks
期刊介绍: The Journal of Anesthesia is the official journal of the Japanese Society of Anesthesiologists. This journal publishes original articles, review articles, special articles, clinical reports, short communications, letters to the editor, and book and multimedia reviews. The editors welcome the submission of manuscripts devoted to anesthesia and related topics from any country of the world. Membership in the Society is not a prerequisite. The Journal of Anesthesia (JA) welcomes case reports that show unique cases in perioperative medicine, intensive care, emergency medicine, and pain management.
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