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前锯肌平面阻滞对胸腔镜肺切除术患者术后早期恢复的影响
贵州医科大学 麻醉与心脏电生理课题组
翻译：王贵龙 编辑：赵游霄 审校：曹莹
背景：前锯肌平面阻滞治疗微创胸部手术后疼痛的疗效尚不清楚。本试验评估了前锯肌平面阻滞对胸腔镜肺切除术后患者阿片类药物消耗和早期恢复的影响。
方法：在单中心接受微创解剖性肺切除术的患者，手术结束时被随机分为两组：前锯肌平面阻滞组（含0.25%布比卡因、可乐定100μg和地塞米松4mg的40ml注射液）和假阻滞组（安慰剂）。主要观察指标为术后24小时内累计静脉注射吗啡量。次要指标是静脉注射吗啡量、休息和咳嗽时的疼痛评分、肺活量测定的吸气量、术后前48小时内恶心或呕吐的发生率、术后7天的恢复质量评分和住院时间。
结果：前锯肌平面阻滞患者（n=46）的静脉注射吗啡量中位数（四分位数间距）为10.6（5.0至27.1）mg，而安慰剂组患者（n=46）为18.8（9.9至29.6）mg（减少32%；[95%CI，0.44至1.06]；P=0.085）。在次要指标中，前锯肌平面阻滞组的复合疼痛和咳嗽评分存在显著差异（95%CI，-0.81至-0.01；P=0.044）。敏感性分析：前锯肌平面阻滞组患者（n=44）的静脉注射吗啡当量中位数（四分位数间距）为10.0mg（5.0至27.2），而安慰剂组患者（n=48）为19.9（10.4至29.0）mg（减少36%；[95%CI，0.41至1.00]；P=0.048）。
结论：在胸腔镜肺切除术后，前锯肌平面阻滞不会显著减少阿片类药物消耗。敏感性分析显示主要指标存在差异，可值得进一步研究。
原始文献：
Jackson JC;Tan KS;Pedoto A;Park BJ;et al; Effects of Serratus Anterior Plane Block on Early Recovery from Thoracoscopic Lung Resection:A Randomized, Blinded, Placebo-controlled Trial.Anesthesiology 141(6)；PMID：39283707
英文原文：
Effects of Serratus Anterior Plane Block on Early Recovery from Thoracoscopic Lung Resection A Randomized, Blinded, Placebo-controlled Tria
BACKGROUND:The efficacy of serratus anterior plane block for treatment of pain after minimally invasive thoracic surgery remains unclear. This trial assesses the impact of serratus anterior plane block on postoperative opioid consumption and on measures of early recovery after thoracoscopic lung resection.
METHODS:Patients undergoing minimally invasive anatomic lung resection at a single center were randomized to undergo serratus anterior plane block with 40 ml injectate containing bupivacaine 0.25%, clonidine 100 μg, and dexamethasone 4 mg (serratus anterior plane block group) or sham block with 40 ml normal saline (placebo group) at the conclusion of surgery. The primary outcome was cumulative intravenous morphine equivalents during the first 24 h postoperatively. Secondary outcomes were intravenous morphine equivalents, pain scores at rest and with cough, inspiratory volume on incentive spirometry, incidence of nausea or vomiting during the first 48 h postoperatively, Quality of Recovery-15 score on postoperative day 7, and length of stay.
RESULTS:Using the protocol-specified intention-to-treat analysis, the median (interquartile range) intravenous morphine equivalents was 10.6 (5.0 to 27.1) mg in serratus anterior plane block patients (n = 46) versus 18.8 (9.9 to 29.6) mg in placebo patients (n = 46; 32% reduction; ratio, 0.68 [95% CI, 0.44 to 1.06]; P = 0.085). Of the secondary outcomes, only the composite pain with cough scores differed significantly in the serratus anterior plane block group by a coefficient of -0.41 (95% CI, -0.81 to -0.01; P = 0.044). A sensitivity as-treated analysis reported median (interquartile range) intravenous morphine equivalents of 10.0 (5.0 to 27.2) mg in serratus anterior plane block patients (n = 44) versus 19.9 (10.4 to 29.0) mg in placebo patients (n = 48; 36% reduction; ratio, 0.64 [95% CI, 0.41 to 1.00]; P = 0.048).
CONCLUSIONS:The protocol-specified intention-to-treat analysis demonstrated that serratus anterior plane block did not result in a significant reduction in opioid consumption when added to a multimodal analgesic regimen after thoracoscopic anatomic lung resection. The sensitivity as-treated analysis showed a significant and modest clinical reduction in the primary outcome that warrants further investigation.
