A Randomized Controlled Trial of Liposomal Bupivacaine Parasternal Intercostal Block for Sternotomy
A Randomized Controlled Trial of Liposomal Bupivacaine Parasternal Intercostal Block for Sternotomy
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DOI：
10.1016/j.athoracsur.2018.06.081
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发表时间：
2019-01-01
影响因子：
4.6
通讯作者：
Knight, Peter A.
中科院分区：
文献类型：
--
作者：
Lee, Candice Y.;Robinson, Davida A.;Knight, Peter A.
背景最佳的疼痛控制仍然是心脏手术中的一个问题。目前的术后疼痛管理策略往往产生次优的结果。Exparel（Pacira Pharmaceuticals，Inc，帕西帕尼，NJ）在提供术后疼痛控制和阿片类药物节省方面的优效性尚不明确。这项前瞻性、随机、双盲研究考察了Exparel作为一种新型单剂量应用胸骨旁神经阻滞在术后疼痛控制和阿片类药物保留方面的疗效。这项由一名外科医生进行的研究包括79名接受正中胸骨切开术进行冠状动脉血运重建的患者。研究参与者被随机分配到药物组或对照组，每名参与者接受Exparel或生理盐水安慰剂作为胸骨旁神经阻滞。根据非语言疼痛量表或数字评分量表对术后疼痛进行评分。比较两组患者术后72小时内麻醉性镇痛药的使用总量和患者的疼痛评分。次要结局比较了重症监护室住院时间、住院时间、拔管时间、肠功能恢复时间和恢复工作或日常活动时间。在分析术后各个时间点时，两组之间的疼痛水平主要终点无显著差异。然而，研究药物组的总体疼痛水平显著较低（p = 0.04）。两组术后镇痛药用量和次要终点无显著差异。与安慰剂相比，Exparel不提供阿片类药物节省益处或任何次要结局益处。Exparel可能与术后疼痛水平的边际降低有关。（心脏病患者的胸骨旁神经阻滞; NCT 01826851。）(C)2019年美国胸外科医师协会
Background. Optimal pain control continues to be a concern in cardiac surgery. Current strategies for post-operative pain management often yield suboptimal results. The superiority of Exparel (Pacira Pharmaceuticals, Inc, Parsippany, NJ) in providing postoperative pain control and opioid sparing is equivocal. This prospective, randomized, double-blind study examines the efficacy of Exparel as a novel single-dose application parasternal nerve block in postoperative pain control and opioid sparing.Methods. This single-surgeon study included 79 patients undergoing median sternotomy for coronary revascularization. Study participants were randomized to either the drug or a control arm. Each participant received Exparel or normal saline placebo administered as a parasternal nerve block. Postoperative pain was rated according to the nonverbal pain scale or numeric rating scale. Total amount of narcotic pain medication used and patients' pain scores within the first 72 hours postoperatively were compared. Secondary outcomes compared the intensive care unit length of stay, hospital length of stay, time to extubation, time to return of bowel function, and time to return to work or daily activities.Results. The primary endpoint of pain levels between the two groups demonstrated no significant difference when analyzing the individual time points postoperatively. However, overall pain levels were significantly lower in the study drug group (p = 0.04). There was no significant difference in the amount of analgesics required postoperatively or in secondary endpoints between the groups.Conclusions. Exparel does not provide an opioid sparing benefit or any secondary outcome benefit compared with placebo. Exparel may be associated with a marginal decrease in postoperative pain levels. (Parsternal Nerve Bock in Cardiac Patients; NCT01826851.) (C) 2019 by The Society of Thoracic Surgeons