超声引导下布比卡因脂质体与非布比卡因脂质体对儿童Nuss手术后术后疼痛控制的椎旁阻滞：一项随机临床试验

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-08-05 DOI:10.1016/j.jclinane.2025.111953

Lei Wu, Si Wei Wei, Zheng Chen, Li Dan Jiang, Shuang Quan Qu, Zhen Du

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引用次数: 0

摘要

研究目的微创修复漏斗胸（Nuss手术）与明显的术后疼痛和大剂量阿片类药物消耗有关。布比卡因脂质体作为一种超长效局麻药，在围手术期镇痛方面得到了广泛的研究。然而，关于LB对接受Nuss手术的儿童术后疼痛的影响的数据仍然有限。本研究的目的是评估LB在接受Nuss手术的儿童中减少术后阿片类药物使用的能力。设计随机对照试验。SettingOperating房间。6-18岁的儿童，他们被安排进行选择性的Nuss手术。干预措施：在麻醉诱导后，患者被随机分配接受超声引导下用LB或非脂质体布比卡因（nLB）进行椎旁阻滞。主要结果是术后72小时内吗啡当量的消耗。次要终点包括72小时内最大数值评定量表（NRS）疼痛评分、72小时内中重度疼痛发生率、72小时内反跳性疼痛发生率、3天内NRS睡眠评分、术后恶心呕吐发生率、术后住院时间、术后第一次下床时间。意向治疗分析共纳入109例受试者。术后72 h内，与nLB组相比，LB组吗啡当量消耗量减少约23%(中位差：23.1 mg；p = 0.023)。LB组反跳痛发生率明显低于nLB组(13.0%[7/54]比29.1%[16/55]，相对危险度0.46；95% ci: 0.20 0.96；p = 0.039)。术后第2、3晚，LB组主观睡眠质量优于nLB组(中位差：−1点；P = 0.005和P = 0.016)。两组不良事件发生率相似，研究期间均无患者发生严重不良事件。结论：与nLB组相比，腰椎阻滞与LB组减少了Nuss手术后儿童阿片类药物的使用（减少约23%）和反跳性疼痛的发生率。试验注册www.chictr.org.cn（注册号ChiCTR2400085350，注册日期2024年6月5日）。

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Ultrasound-guided paravertebral block with liposomal bupivacaine vs. non-liposomal bupivacaine for postoperative pain control after the Nuss procedure in children: A randomized clinical trial

Study objective

Minimally invasive repair of pectus excavatum (Nuss procedure) is associated with significant postoperative pain and high-dose opioid consumption. Liposomal bupivacaine (LB), as an ultra-long-acting local anesthetic, has been extensively studied for perioperative analgesia. However, data regarding the effects of LB on postoperative pain in children undergoing the Nuss procedure remain limited. The aim of this study was to evaluate the ability of LB to reduce postoperative opioid use among children undergoing the Nuss procedure.

Design

Randomized controlled trial.

Setting

Operating room.

Patients

Children aged 6–18 years who were scheduled for elective Nuss procedures.

Interventions

Patients were randomly assigned to receive ultrasound-guided paravertebral block with either LB or non-liposomal bupivacaine (nLB) after anesthesia induction.

Measurements

The primary outcome was the consumption of morphine equivalent during the first 72 h after surgery. The secondary endpoints included the maximum Numerical Rating Scale (NRS) pain score within 72 h, incidence of moderate-to-severe pain within 72 h, incidence of rebound pain within 72 h, NRS sleep score at 3 days, incidence of postoperative nausea and vomiting, length of hospital stay after surgery, and time to first ambulation after the operation.

Main results

A total of 109 subjects were included in the intention-to-treat analysis. Within 72 h after surgery, the morphine equivalent consumption in the LB group was reduced by about 23 % compared with the nLB group (median difference: 23.1 mg; P = 0.023). The incidence of rebound pain was significantly lower in the LB group than in the nLB group (13.0 % [7/54] vs. 29.1 % [16/55], relative risk 0.46; 95 % CI: 0.20 0.96; P = 0.039). Subjective sleep quality was better in the LB group than in the nLB group on the second and third nights after surgery (median difference: −1 point; P = 0.005 and P = 0.016). The incidence of adverse events was similar in both groups, and no patients experienced severe adverse events during the study period.

Conclusions

Paravertebral bock with LB reduces opioid use (a ∼ 23 % reduction) and the incidence of rebound pain in children after the Nuss procedure compared to nLB group.

Trial registration

www.chictr.org.cn (Registration number ChiCTR2400085350, Registration date June 5, 2024).

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.