A retrospective study comparing analgesic efficacy of ultrasound-guided serratus anterior plane block versus intravenous fentanyl infusion in patients with multiple rib fractures.
A retrospective study comparing analgesic efficacy of ultrasound-guided serratus anterior plane block versus intravenous fentanyl infusion in patients with multiple rib fractures.
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DOI：
10.4103/joacp.joacp_349_19
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发表时间：
2021-07
期刊：
影响因子：
--
通讯作者：
Nair A
中科院分区：
文献类型：
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作者：
Diwan S;Nair A
由于多发性肋骨骨折（MRF）引起的疼痛管理不当可能导致肺不张、肺炎、ICU住院时间延长，从而导致严重的发病率、发病率和治疗费用。阿片类药物，非甾体抗炎药和区域麻醉技术，如胸硬膜外或椎旁阻滞，肋间神经阻滞用于管理疼痛。前锯肌平面阻滞（SAPB）是一种超声（US）引导的筋膜间平面阻滞，已用于治疗MRF引起的疼痛。在这项回顾性研究中，我们比较了MRF患者的镇痛效果和24小时芬太尼消耗量，这些患者接受连续SAPB治疗，而这些患者仅接受芬太尼输注治疗。在机构伦理委员会批准后，我们回顾性收集了72例患者的数据（SAPB组38例，芬太尼组34例）。分析两组的人口统计学数据、VAS评分和24小时芬太尼消耗量。SAPB组患者的疼痛评分显著低于芬太尼组（p=0.001），连续SAPB组患者的24小时芬太尼消耗量显著低于芬太尼组（p=0.001）。在接受US引导SAPB的患者中未观察到并发症。超声引导SAPB是一种阿片类药物保留，有效的筋膜间平面阻滞，是安全的，应该在所有维持MRF的患者中早期考虑。通过放置导管持续SAPB可以提供更长时间的疼痛缓解，有利于早期活动，物理治疗和早期ICU出院。
Inadequately managed pain due to multiple rib fractures (MRFs) can lead to atelectasis, pneumonia, prolonged ICU stay thereby leads to significant morbidity, morbidity and cost of treatment. Opioids, non-steroidal anti-inflammatory drugs and regional anaesthesia techniques like thoracic epidural or paravertebral blocks, intercostal nerve blocks are used to manage pain. Serratus anterior plane block (SAPB) is an ultrasound (US) guided interfascial plane block which has been used in managing pain due to MRFs. In this retrospective study, we compared analgesic efficacy and 24 hr fentanyl consumption in patients with MRFs who were managed with continuous SAPB versus patients who were managed with fentanyl infusion alone. After Institutional Ethics Committee approval, we retrospectively collected data of 72 patients (38 in SAPB group and 34 in fentanyl group). Demographic data, VAS scores and 24 hrs fentanyl consumption was analysed in both groups. There were statistically significant lower pain scores in patients of SAPB group when compared to that of fentanyl group (p=0.001) and in 24 hrs fentanyl consumption in patients who received continuous SAPB versus that in fentanyl group(p=0.001). No complications were observed in patients who received US guided SAPB. US guided SAPB is an opioid sparing, effective interfascial plane block which is safe and should be considered early in all patients who sustain MRFs. Continuous SAPB by placing a catheter can provide pain relief for longer duration, facilitate early mobilization, physiotherapy and early ICU discharge.