比较竖脊肌平面阻滞与胸壁神经II阻滞在乳腺癌手术的镇痛效果:

一项随机对照试验

贵州医科大学     麻醉与心脏电生理课题组

翻译：安丽  编辑：张中伟  审核：曹莹

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摘

要

背景：区域麻醉技术是乳腺癌手术中主要的镇痛技术。新的技术包括胸壁神经(PECS)阻滞和竖脊肌平面(ESP)阻滞。本研究比较了超声引导下ESP与PECS-II阻滞在单侧乳腺癌改良根治术(MRM)患者的镇痛效果。

方法：在本次前瞻性随机对照试验中，对在全身麻醉下实施单侧MRM女性患者60例纳入本项研究。将其随机分为两组：单次ESP阻滞组(n = 30)和PECS-II阻滞组(n = 30)。采用平面内方法在T4平面进行ESP区域阻滞；在第三肋骨水平胸大肌、胸小肌和前锯肌之间实施区域阻滞。两组注射体积均为20ml 0.25%的布比卡因。观察指标为吗啡总用量、镇痛持续时间、术后疼痛强度、恶心呕吐发生情况。

结果：与PECS组相比，ESP组对吗啡镇痛的需求增多(P = 0.028)。ESP组吗啡总消耗量明显高于PECS组(P = 0.005)，ESP组镇痛时间明显短于PECS组(P = 0.003)。ESP组在术后1、2、6 h中疼痛强度需求较高。

结论：在乳腺癌术后疼痛控制方面，PECS-II阻滞比ESP阻滞更有效，其还延长了镇痛的持续时间，减少了术后24小时对吗啡的用量。

原始文献来源：Ahmed Bakeer and Nasr Mahmoud Abdallah.Erector Spinae Plane Block Versus PECS Block Type II for Breast Surgery: A Randomized Controlled Trial.Anesth Pain Med. 2022 April; 12(2):e122917.doi: 10.5812/aapm-122917.

英文原文

Erector Spinae Plane Block Versus PECS Block Type II for Breast Surgery: A Randomized Controlled Trial

Abstract

Background: Regional anesthetic techniques are the primary analgesic techniques in breast cancer surgery. Novel techniques include the pectoralis (PECS) block and the erector spinae plane (ESP) block.

Objectives: This study compared the analgesic efficacy of ultrasound-guided ESP and PECS-II blocks in patients undergoing unilateral modified radical mastectomy (MRM).

Methods: The current prospective randomized controlled trial investigated 60 females scheduled for unilateralMRM under generalanesthesia. The  (n = 30) and a PECS-II block (n = 30)The ESP block was conducted at the level T4 using an in-plane approach. A volume of 20 ml of bupivacaine 0.25% was administered in both blocks. The outcome measures were total morphine consumption, analgesia duration, postoperative pain intensity, and nausea and vomiting.

Results: More ESP participants required rescue morphine analgesia than those in the PECS group (P = 0.028). The ESP group showed significantly higher total morphine consumption (P = 0.005) and a shorter time to request analgesia (P = 0.003). Pain intensity was higher in the ESP group 1, 2, and 6 hours after the surgery.

Conclusions: The PECS-II block is more effective in postoperative pain control after breast cancer surgery than the ESP block. It also prolongs the duration of analgesia and reduces the need for morphine 24 hours after the surgery.

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