Bilateral Paravertebral Block versus Thoracic Epidural Analgesia for Pain Control Post-Cardiac Surgery: A Randomized Controlled Trial
Bilateral Paravertebral Block versus Thoracic Epidural Analgesia for Pain Control Post-Cardiac Surgery: A Randomized Controlled Trial
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DOI：
10.1055/s-0038-1668496
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发表时间：
2020-08-01
影响因子：
1.5
通讯作者：
Arafat, Amr A.
中科院分区：
文献类型：
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作者：
El Shora, Hatem A.;El Beleehy, Ahmed A.;Arafat, Amr A.
背景心脏手术后适当的疼痛控制是必不可少的。椎旁阻滞是一种简单的技术，避免了硬膜外导管的潜在并发症。本研究的目的是比较超声引导下双侧胸段椎旁阻滞与胸段硬膜外阻滞对心脏手术后疼痛控制的效果。材料与方法2016年3月至2017年3月，145例经胸骨正中切口行心脏手术的患者采用分层区组随机分为两组。I组（n = 70例患者）采用双侧超声引导下胸椎旁阻滞，II组（n = 75例患者）采用胸椎硬膜外镇痛。主要终点是术后视觉模拟评分（VAS）。机械通气时间、重症监护室（ICU）和住院时间为次要终点。研究设计为随机化平行优效性临床试验。结果两组患者术前及术中特征相似。两组在气管内拔管后即刻以及12、24和48小时后测量的VAS无显著差异（p = 0.45）。疼痛评分随着重复测量而显著下降（p < 0.001），并且这种下降与治疗组无关。术后疼痛与糖尿病显著相关（p = 0.039）。组I中的6名患者（8.5%）需要额外剂量的吗啡，而组II中的3名患者（4%）需要额外剂量的吗啡（p = 0.30）。I组患者的ICU停留时间显著缩短（p = 0.005），尿潴留（p = 0.04）和呕吐（p = 0.018）的发生率较低。两组手术并发症无差异。结论超声引导下椎旁神经阻滞是一种安全有效的缓解心脏术后疼痛的方法，与胸段硬膜外镇痛相比无上级。
Background Adequate pain control after cardiac surgery is essential. Paravertebral block is a simple technique and avoids the potential complications of epidural catheters. The objective of this study is to compare the effect of ultrasound-guided bilateral thoracic paravertebral block with thoracic epidural block on pain control after cardiac surgery. Materials and Methods Between March 2016 and 2017, 145 patients who had cardiac surgery through median sternotomy were randomized by stratified blocked randomization into two groups. Group I (n = 70 patients) had bilateral ultrasound-guided thoracic paravertebral block and Group II (n = 75 patients) had thoracic epidural analgesia. The primary end point was the postoperative visual analogue scale (VAS). The duration of mechanical ventilation, intensive care unit (ICU), and hospital stay were the secondary end points. The study design is a randomized parallel superiority clinical trial. Results Both groups had similar preoperative and operative characteristics. No significant difference in VAS measured immediately after endotracheal extubation then after 12, 24, and 48 hours between groups (p = 0.45). Pain score significantly declined with the repeated measures (p < 0.001) and the decline was not related to the treatment group. Postoperative pain was significantly related to diabetes mellitus (p = 0.039). Six patients in group I (8.5%) required an additional dose of morphine versus three patients (4%) in group II (p = 0.30). Patients in group I had significantly shorter ICU stay (p = 0.005) and lower incidence of urinary retention (p = 0.04) and vomiting (p = 0.018). No difference was found in operative complications between groups. Conclusion This randomized parallel controlled trial demonstrates that ultrasound-guided paravertebral block is safe and effective method for relieving post-cardiac surgery sternotomy pain compared with thoracic epidural analgesia but not superior to it.