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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接受二尖瓣/三尖瓣修复的患者使用脊柱平面阻滞和胸大肌阻滞进行术后疼痛治疗-一项随机对照试验。

背景技术有效的术后疼痛控制仍然是接受心脏手术的患者的挑战。新型的区域性阻滞措施可以改善此类患者的疼痛管理，并可以缩短他们在医院的住院时间。为了比较接受直立脊柱平面（ESP）阻滞或ESP与胸大肌（PECS）阻滞合并心脏手术的患者的术后疼痛强度。方法这是在一家三级医院进行的前瞻性，随机，对照，双盲研究。包括通过微型开胸术进行二尖瓣/三尖瓣修复的30例患者。将患者随机分为两组：ESP或PECS + ESP组（1：1随机分组）。两组患者均接受超声引导的单次ESP阻滞。PECS + ESP组的参与者收到了其他PECS块。每个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。主要结局是术后第一天通过PCA消耗的羟考酮总量。次要结果包括以视觉模拟量表（VAS）测量的疼痛强度，患者满意度，亨利王子医院疼痛评分（PHHPS）和肺活量测定法。结果PECS + ESP组患者使用的羟考酮明显少于ESP组：中位12 [四分位间距（IQR）：6-16] mg与20 [IQR：18-29] mg（p = 0.0004）。此外，在术后第一天中的五次测量中，PECS + ESP组的疼痛强度显着降低。PECS + ESP组的患者对疼痛的治疗更加满意。两组在PHHPS和肺活量测定方面没有发现差异。结论在ESP中添加PECS阻滞剂可减少通过PCA进行羟考酮的消耗，降低VAS上的疼痛强度，并提高了通过微型胸廓切开术进行二尖瓣/三尖瓣修复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（首次发布）在ClinicalTrials.gov上进行了注册，标识符为NCT03592485。