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。

IF 2.1 4区 医学 Q2 ANESTHESIOLOGY
Rajesh Madavathazathil Gopalakrishnan, Nilkanth Shinde, A R Meghalakshmi, Georg Gutjahr, Malavika Krishnakumar, Sreelakshmi P Leeladharan, Diana Thomas, Sharath Padmanabhan, Raman Krishnakumar
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引用次数: 0

摘要

目的:比较椎板后阻滞(RLB)与竖脊肌平面阻滞(ESPB)在小儿心脏外科围手术期镇痛中的疗效和安全性。设计:前瞻性、随机、双盲、对照、非劣效性试验。环境:在印度南部三级保健转诊中心的儿科心脏外科单位。参与者:年龄在1天至18岁之间的儿童,他们计划进行择期心脏手术(先天性心脏手术风险调整类别1-6)。共有298名患者被随机分配接受ESPB或RLB,每组149名患者。干预:由四名麻醉师中的一名进行肌筋膜阻滞,根据指定的组,每位麻醉师在超声指导下给予ESPB或RLB。治疗麻醉师和重症监护病房(ICU)重症监护医师盲法分组。测量和主要结果:本研究比较了RLB(一种更安全且较少使用的后肌筋膜阻滞)和ESPB(一种广泛采用且并发症少的技术),以建立RLB的非效性。主要终点是手术切口的血流动力学反应,定义为心率上升超过10%。次要结局包括阻滞给药时间;术中吸入麻醉;右美托咪定和阿片类药物的使用;术后2、6、12小时疼痛和镇静评分;和ICU预后,如机械通气持续时间、ICU住院时间、再插管率、一次性呼吸机和氧气费用。两组的基线特征具有可比性。ESPB组46%的患者心率升高超过10%,RLB组50% (p = 0.3)。两组之间术中药物消耗、疼痛和镇静评分以及ICU结果相似。结论:RLB在小儿心脏手术中的应用不逊于ESPB,具有相当的镇痛效果、安全性和术后恢复效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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.

Design: Prospective, randomized, double-blinded, controlled, noninferiority trial.

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.

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来源期刊
CiteScore
4.80
自引率
17.90%
发文量
606
审稿时长
37 days
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.
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