BACKGROUND Effective postoperative pain control remains a challenge for patients undergoing cardiac surgery. Novel regional blocks may improve pain management for such patients and can shorten their length of stay in the hospital. To compare postoperative pain intensity in patients undergoing cardiac surgery with either erector spinae plane (ESP) block or combined ESP and pectoralis nerve (PECS) blocks. METHODS This was a prospective, randomized, controlled, double-blinded study done in a tertiary hospital. Thirty patients undergoing mitral/tricuspid valve repair via mini-thoracotomy were included. Patients were randomly allocated to one of two groups: ESP or PECS + ESP group (1:1 randomization). Patients in both groups received a single-shot, ultrasound-guided ESP block. Participants in PECS + ESP group received additional PECS blocks. Each patient had to be extubated within 2 h from the end of the surgery. Pain was treated via a patient-controlled analgesia (PCA) pump. The primary outcome was the total oxycodone consumption via PCA during the first postoperative day. The secondary outcomes included pain intensity measured on the visual analog scale (VAS), patient satisfaction, Prince Henry Hospital Pain Score (PHHPS), and spirometry. RESULTS Patients in the PECS + ESP group used significantly less oxycodone than those in the ESP group: median 12 [interquartile range (IQR): 6-16] mg vs. 20 [IQR: 18-29] mg (p = 0.0004). Moreover, pain intensity was significantly lower in the PECS + ESP group at each of the five measurements during the first postoperative day. Patients in the PECS + ESP group were more satisfied with pain management. No difference was noticed between both groups in PHHPS and spirometry. CONCLUSIONS The addition of PECS blocks to ESP reduced consumption of oxycodone via PCA, reduced pain intensity on the VAS, and increased patient satisfaction with pain management in patients undergoing mitral/tricuspid valve repair via mini-thoracotomy. TRIAL REGISTRATION The study was registered on the 19th July 2018 (first posted) on the ClinicalTrials.gov identifier: NCT03592485.

中文翻译：

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使用竖脊肌平面阻滞和胸肌神经阻滞治疗接受二尖瓣/三尖瓣修复术的患者术后疼痛——一项随机对照试验。


背景技术有效的术后疼痛控制对于接受心脏手术的患者来说仍然是一个挑战。新型区域阻滞可以改善此类患者的疼痛管理，并可以缩短他们的住院时间。比较接受竖脊肌平面 (ESP) 阻滞或联合 ESP 和胸肌神经 (PECS) 阻滞的心脏手术患者术后疼痛强度。方法 这是一项在三级医院进行的前瞻性、随机、对照、双盲研究。包括 30 名通过小型开胸手术接受二尖瓣/三尖瓣修复术的患者。患者被随机分配至两组中的一组：ESP 组或 PECS + ESP 组（1:1 随机化）。两组患者均接受单次超声引导 ESP 阻滞。 PECS + ESP 组的参与者获得了额外的 PECS 块。每位患者必须在手术结束后2小时内拔管。通过患者自控镇痛（PCA）泵治疗疼痛。主要结果是术后第一天通过 PCA 的羟考酮总消耗量。次要结果包括视觉模拟量表（VAS）测量的疼痛强度、患者满意度、亨利王子医院疼痛评分（PHHPS）和肺活量测定。结果 PECS + ESP 组患者使用的羟考酮明显少于 ESP 组：中位数 12 [四分位距 (IQR)：6-16] mg 对比 20 [IQR：18-29] mg (p = 0.0004)。此外，术后第一天的五次测量中，PECS + ESP 组的疼痛强度明显较低。 PECS + ESP 组的患者对疼痛管理更加满意。两组之间的PHHPS 和肺活量测定没有差异。 结论 在 ESP 中添加 PECS 阻滞可减少通过 PCA 的羟考酮消耗量，降低 VAS 的疼痛强度，并提高接受小切口开胸二尖瓣/三尖瓣修复术的患者对疼痛管理的满意度。试验注册 该研究于 2018 年 7 月 19 日在 ClinicalTrials.gov 上注册（首次发布），标识符：NCT03592485。