Rajesh Madavathazathil Gopalakrishnan, Nilkanth Shinde, A R Meghalakshmi, Georg Gutjahr, Malavika Krishnakumar, Sreelakshmi P Leeladharan, Diana Thomas, Sharath Padmanabhan, Raman Krishnakumar
{"title":"竖脊肌平面阻滞与椎板后阻滞用于小儿心脏手术围手术期镇痛:一项随机、双盲、非劣效性临床试验。","authors":"Rajesh Madavathazathil Gopalakrishnan, Nilkanth Shinde, A R Meghalakshmi, Georg Gutjahr, Malavika Krishnakumar, Sreelakshmi P Leeladharan, Diana Thomas, Sharath Padmanabhan, Raman Krishnakumar","doi":"10.1053/j.jvca.2025.08.029","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To compare the efficacy and safety of retrolaminar block (RLB) with erector spinae plane block (ESPB) for perioperative analgesia in pediatric cardiac surgery.</p><p><strong>Design: </strong>Prospective, randomized, double-blinded, controlled, noninferiority trial.</p><p><strong>Setting: </strong>A pediatric cardiac surgical unit at a tertiary care referral center in South India.</p><p><strong>Participants: </strong>Children aged between 1 day and 18 years who were scheduled for elective cardiac surgery (Risk adjustment for congenital heart surgery categories 1-6) were enrolled in the study. A total of 298 patients were randomly assigned to receive either an ESPB or RLB, with 149 patients in each group.</p><p><strong>Intervention: </strong>Myofascial blocks were performed by one of four anesthesiologists, each administering either ESPB or RLB under ultrasound guidance according to the assigned group. The treating anesthesiologist and intensive care unit (ICU) intensivist were blinded to group allocation.</p><p><strong>Measurements and main results: </strong>This study compared RLB, a safer and less commonly used posterior myofascial block, with ESPB, a widely adopted technique with few reported complications, to establish the noninferiority of RLB. The primary outcome was hemodynamic response to surgical incision, defined as a greater than 10% rise in heart rate. Secondary outcomes included block administration time; intraoperative inhalational anesthetic; dexmedetomidine and opioid use; postoperative pain and sedation scores at 2, 6, and 12 hours; and ICU outcomes such as duration of mechanical ventilation, ICU length of stay, reintubation rate, and cost of ventilator disposables and oxygen. The groups were comparable in baseline characteristics. A rise in heart rate of more than 10% was observed in 46% of patients in the ESPB group and 50% in the RLB group (p = 0.3). Intraoperative drug consumption, pain and sedation scores, as well as ICU outcomes, were similar between the groups.</p><p><strong>Conclusions: </strong>RLB is noninferior to ESPB in pediatric cardiac surgery, providing comparable analgesic efficacy, safety, and postoperative recovery outcomes.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":" ","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Erector Spinae Plane Block Versus Retrolaminar Block for Perioperative Analgesia in Pediatric Cardiac Surgery: A Randomized, Double-blinded, Noninferiority Clinical Trial.\",\"authors\":\"Rajesh Madavathazathil Gopalakrishnan, Nilkanth Shinde, A R Meghalakshmi, Georg Gutjahr, Malavika Krishnakumar, Sreelakshmi P Leeladharan, Diana Thomas, Sharath Padmanabhan, Raman Krishnakumar\",\"doi\":\"10.1053/j.jvca.2025.08.029\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To compare the efficacy and safety of retrolaminar block (RLB) with erector spinae plane block (ESPB) for perioperative analgesia in pediatric cardiac surgery.</p><p><strong>Design: </strong>Prospective, randomized, double-blinded, controlled, noninferiority trial.</p><p><strong>Setting: </strong>A pediatric cardiac surgical unit at a tertiary care referral center in South India.</p><p><strong>Participants: </strong>Children aged between 1 day and 18 years who were scheduled for elective cardiac surgery (Risk adjustment for congenital heart surgery categories 1-6) were enrolled in the study. A total of 298 patients were randomly assigned to receive either an ESPB or RLB, with 149 patients in each group.</p><p><strong>Intervention: </strong>Myofascial blocks were performed by one of four anesthesiologists, each administering either ESPB or RLB under ultrasound guidance according to the assigned group. The treating anesthesiologist and intensive care unit (ICU) intensivist were blinded to group allocation.</p><p><strong>Measurements and main results: </strong>This study compared RLB, a safer and less commonly used posterior myofascial block, with ESPB, a widely adopted technique with few reported complications, to establish the noninferiority of RLB. The primary outcome was hemodynamic response to surgical incision, defined as a greater than 10% rise in heart rate. Secondary outcomes included block administration time; intraoperative inhalational anesthetic; dexmedetomidine and opioid use; postoperative pain and sedation scores at 2, 6, and 12 hours; and ICU outcomes such as duration of mechanical ventilation, ICU length of stay, reintubation rate, and cost of ventilator disposables and oxygen. The groups were comparable in baseline characteristics. A rise in heart rate of more than 10% was observed in 46% of patients in the ESPB group and 50% in the RLB group (p = 0.3). Intraoperative drug consumption, pain and sedation scores, as well as ICU outcomes, were similar between the groups.</p><p><strong>Conclusions: </strong>RLB is noninferior to ESPB in pediatric cardiac surgery, providing comparable analgesic efficacy, safety, and postoperative recovery outcomes.</p>\",\"PeriodicalId\":15176,\"journal\":{\"name\":\"Journal of cardiothoracic and vascular anesthesia\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2025-08-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of cardiothoracic and vascular anesthesia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1053/j.jvca.2025.08.029\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of cardiothoracic and vascular anesthesia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1053/j.jvca.2025.08.029","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
Erector Spinae Plane Block Versus Retrolaminar Block for Perioperative Analgesia in Pediatric Cardiac Surgery: A Randomized, Double-blinded, Noninferiority Clinical Trial.
Objective: To compare the efficacy and safety of retrolaminar block (RLB) with erector spinae plane block (ESPB) for perioperative analgesia in pediatric cardiac surgery.
Setting: A pediatric cardiac surgical unit at a tertiary care referral center in South India.
Participants: Children aged between 1 day and 18 years who were scheduled for elective cardiac surgery (Risk adjustment for congenital heart surgery categories 1-6) were enrolled in the study. A total of 298 patients were randomly assigned to receive either an ESPB or RLB, with 149 patients in each group.
Intervention: Myofascial blocks were performed by one of four anesthesiologists, each administering either ESPB or RLB under ultrasound guidance according to the assigned group. The treating anesthesiologist and intensive care unit (ICU) intensivist were blinded to group allocation.
Measurements and main results: This study compared RLB, a safer and less commonly used posterior myofascial block, with ESPB, a widely adopted technique with few reported complications, to establish the noninferiority of RLB. The primary outcome was hemodynamic response to surgical incision, defined as a greater than 10% rise in heart rate. Secondary outcomes included block administration time; intraoperative inhalational anesthetic; dexmedetomidine and opioid use; postoperative pain and sedation scores at 2, 6, and 12 hours; and ICU outcomes such as duration of mechanical ventilation, ICU length of stay, reintubation rate, and cost of ventilator disposables and oxygen. The groups were comparable in baseline characteristics. A rise in heart rate of more than 10% was observed in 46% of patients in the ESPB group and 50% in the RLB group (p = 0.3). Intraoperative drug consumption, pain and sedation scores, as well as ICU outcomes, were similar between the groups.
Conclusions: RLB is noninferior to ESPB in pediatric cardiac surgery, providing comparable analgesic efficacy, safety, and postoperative recovery outcomes.
期刊介绍:
The Journal of Cardiothoracic and Vascular Anesthesia is primarily aimed at anesthesiologists who deal with patients undergoing cardiac, thoracic or vascular surgical procedures. JCVA features a multidisciplinary approach, with contributions from cardiac, vascular and thoracic surgeons, cardiologists, and other related specialists. Emphasis is placed on rapid publication of clinically relevant material.