Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.04.004
Brazilian Journal of Anesthesiology
Original Investigation

Effects of erector spinae plane block and retrolaminar block on analgesia for multiple rib fractures: a randomized, double-blinded clinical trial

Efeitos do bloqueio do plano eretor da espinha e do bloqueio retrolaminar na analgesia para fraturas de costelas múltiplas: um ensaio clínico duplo-cego randomizado

Yaoping Zhao; Yan Tao; Shaoqiang Zheng; Nan Cai; Long Cheng; Hao Xie; Geng Wang

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Abstract

Objective: To investigate the effects of Erector Spinae Plane Block (ESPB) and Retrolaminar Block (RLB) on intra- and postoperative analgesia in patients with Multiple Rib Fractures (MRFs).

Methods: A total of 80 MRFs patients were randomly divided into the ESPB (Group E) and RLB (Group R) groups. After general anesthesia, ESPB and RLB were performed under ultrasound guidance, respectively, together with 20 mL of 0.5% ropivacaine and Patient-Controlled Intravenous Analgesia (PCIA).

Results: Thirty-four cases in Group E and 33,cases in Group R showed unclear paravertebral spaces. The intraoperative dosage of remifentanil (mean ± SD) (392.8 ± 118.7 vs. 501.7 ± 190.0 µg) and postoperative morphine PCIA dosage, (7.35 ± 1.55 vs. 14.73 ± 2.18 mg) in Group R were significantly less than those in Group E; the Visual Analog Scale (VAS) scores in Group R at 2 (2.7 ± 1.2 vs. 3.4 ± 1.4), 4 (2.2 ± 1.1 vs. 2.8 ± 0.9), 12 (2.5 ± 0.9 vs. 3.0 ± 0.8), and 24 hours (2.6 ± 1.0 vs. 3.1 ± 0.9) after surgery were significantly lower than those in Group E. Finally, the normal respiratory diaphragm activity (2.17 ± 0.22 vs. 2.05 ± 0.19), pH (median [IQR] (7.38 [7.31-7.45] vs. 7.36 [7.30-7.42]), and partial pressure of carbon dioxide (PaCO2) (44 [35-49] vs. 42.5 [30-46]) after the operation in Group R were significantly better than those in Group E (p < 0.05).

Conclusions: RLB was a more effective analgesic method than ESPB in the treatment of MRF.

Keywords

Clinical trial, Rib fractures, Nerve block, Ultrasound imaging, Analgesia

Resumo

Objetivo: Investigar os efeitos do Bloco Plano Eretor da Espinha (ESPB) e do Bloco Retrolaminar (RLB) na analgesia intra e pós-operatória em pacientes com Fraturas Múltiplas de Costelas (MRFs). 

Métodos: 80 pacientes com MRFs foram divididos aleatoriamente nos grupos ESPB (Grupo E) e RLB (Grupo R). Após anestesia geral, ESPB e RLB foram realizados sob orientação de ultrassom, respectivamente, juntamente com 20 mL de ropivacaína a 0,5% e analgesia intravenosa controlada pelo paciente (PCIA).

Resultados: Trinta e quatro casos no Grupo E e 33, casos no Grupo R apresentaram espaços paravertebrais obscuros. A dosagem intraoperatoria de remifentanil (média ± DP) (392,8 ± 118,7 vs. 501,7 ± 190,0 μg) e a dosagem de morfina PCIA pós-operatória, (7,35 ± 1,55 vs. 14,73 ± 2,18 mg) no Grupo R foram significativamente menores do que aquelas no Grupo E ; as pontuações da Escala Visual Analógica (VAS) no Grupo R em 2 (2,7 ± 1,2 vs. 3,4 ± 1,4), 4 (2,2 ± 1,1 vs. 2,8 ± 0,9), 12 (2,5 ± 0,9 vs. 3,0 ± 0,8) e 24 horas (2,6 ± 1,0 vs. 3,1 ± 0,9) após a cirurgia foram significativamente menores do que aquelas no Grupo E. 

Finalmente, a atividade respiratória normal do diafragma (2,17 ± 0,22 vs. 2,05 ± 0,19), pH (mediana [IQR] (7,38 [7,31-7,45] vs. 7,36 [7,30-7,42]) e pressão parcial de carbono dióxido (PaCO2) (44 [35-49] vs. 42,5 [30-46]) após a operação no Grupo R foram significativamente melhores do que no Grupo E (p <0,05).

Conclusões: RLB foi um método analgésico mais eficaz do que ESPB no tratamento de MRF.

Palavras-chave

Ensaio clínico, Fraturas de costelas, Bloqueio nervoso, Imagem de ultrassom, Analgesia

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Submitted date:
09/09/2019

Accepted date:
04/02/2021

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Braz J Anesthesiol

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