勃起器脊柱平面阻塞提供了与胸部准脊柱阻塞相比较的止痛效果,为乳房挖掘器进行儿科后的Nuss程序:一项随机对照试验
Min Xu1, Guangchao Zhang1, Rui Wang1
1Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Pain physician
|October 1, 2024
概括
勃起器脊柱平面阻塞 (ESPB) 在儿科Nuss手术中提供与胸部副脊柱阻塞 (TPVB) 相比的缓解疼痛. 这项研究发现,ESPB在治疗术后疼痛和阿片类药物消费方面具有非劣势,这表明了更安全的替代方案.
科学领域:
- 儿科麻醉学 儿科麻醉学
- 疼痛管理 疼痛管理
- 胸部外科手术 胸部外科手术
背景情况:
- 胸部副脊椎阻塞 (TPVB) 是儿科Nuss手术的常见止痛技术,但存在风险.
- 勃起器脊柱平面阻塞 (ESPB) 是一个潜在的更安全的替代方案,易于管理.
- 在小儿Nuss手术后,ESPB与TPVB的镇痛效果的比较仍然不清楚.
研究的目的:
- 在接受Nuss手术的儿童中,比较超声导向ESPB和TPVB的止痛效果.
- 为了确定ESPB是否与TPVB相比提供非劣质的止痛.
主要方法:
- 在中国进行的前性,随机化,非劣等性试验.
- 68名儿童 (4-18岁) 接受了超声波引导的双边T5级ESPB或TPVB与罗皮瓦卡因后麻醉.
- 主要结局:休息时的疼痛评分和手术后24小时. 二次结果:阿片类药物消费,兴奋,慢性疼痛,副作用.
主要成果:
- 在治疗后24小时内,ESPB对静止疼痛评分与TPVB的评分不逊色 (中位数差异为0.95%,CI为0至1).
- 在各组之间,阿片类药物消费是相似的 (ESPB: 37.7 mg vs TPVB: 36.9 mg),ESPB证实非劣势 (95% CI上限7.9 vs 10幅度).
- 在咳期间的疼痛,慢性疼痛发生率,出现动荡或副作用方面没有观察到显著的差异.
结论:
- 在儿科Nuss手术中,手术前的ESPB与多模式止痛疗法在疼痛评分和阿片类药物消耗方面不低于TPVB.
- ESPB证明了与TPVB相比较的止痛疗效和安全性.
- 进一步的研究应该探索以患者为中心的结果和更大的样本大小.
相关概念视频
Skeletal Muscle Relaxants: Therapeutic Uses
475
Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx...
475
Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions
401
Nondepolarizing neuromuscular blockers prevent the membrane depolarization of muscle cells and inhibit muscle contraction. These are usually administered with anesthetics to achieve complete muscle relaxation. Upon administration, these drugs first block the small, rapidly contracting muscles of the face and hands, followed by the larger muscles of the trunk and the intercostal muscles. The diaphragm is the last muscle to be affected.
Although all competitive neuromuscular blockers are designed...
Although all competitive neuromuscular blockers are designed...
401
Depolarizing Blockers: Pharmocokinetics
315
Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
315
Local Anesthetics: Clinical Application as Spinal Anesthesia
591
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
591


