超声引导下的区域神经阻滞在心脏手术中的应用-国际临床研究杂志-CSCIED科技核心评价数据库-手机版

超声引导下的区域神经阻滞在心脏手术中的应用

Ultrasound-guided regional nerve blocks in cardiac surgery

ES评分 0 浏览量：493 下载量：0

DOI	10.12208/j.ijcr.20240048
刊名	国际临床研究杂志 International Journal of Clinical Research
年，卷(期)	2024, 8(2)
作者	孙晓璐*,
作者单位	北京医院麻醉科北京；国家老年医学中心湖南长沙；中国科学院老年医学研究所北京 ;
摘要	心脏手术后的疼痛很常见，可以由直接的手术操作引起，也可由间接的炎症刺激引起。疼痛控制不佳还会导致围手术期应激激素释放、交感神经刺激，导致血液动力学变化和心肌耗氧量增加。充分的镇痛是确保患者舒适、低发病率、早期下地活动和降低成本的先决条件。研究发现阿片类药的使用与不良反应有关，并且减少阿片类药物的使用可能促进患者早期康复，因此多模式镇痛应运而生。然而基于药物组合的多模式镇痛也存在缺点，区域麻醉/镇痛是多模式镇痛的有效替代方案。近年来，随着超声技术的进步，加速了神经阻滞在心脏手术镇痛的发展，超声引导下神经阻滞可以实时观察穿刺针的行进过程、目标神经的详细结构、血管的有效规避、局麻药的扩散，具有突出的优势。本综述旨在介绍不同超声引导下神经阻滞方法在心脏手术镇痛中的应用，以期对心脏手术患者行更好的围术期疼痛管理。
Abstract	Pain after cardiac surgery is common and can be caused by direct surgical procedures or indirect inflammatory stimuli. Poor pain control also leads to perioperative stress hormone release, sympathetic nerve stimulation, resulting in hemodynamic changes and increased myocardial oxygen consumption. Adequate analgesia is a prerequisite for ensuring patient comfort, low morbidity, early ground movement and reduced costs. Studies have found that opioid use is associated with adverse reactions, and that reducing opioid use may promote early recovery in patients, so multimodal analgesia was created. However, multi-modal analgesia based on drug combinations also has disadvantages, and regional anesthesia/analgesia is an effective alternative to multi-modal analgesia. In recent years, with the advancement of ultrasound technology, the development of nerve block in cardiac surgery analgesia has been accelerated. Under ultrasound guidance, nerve block can observe the process of puncture needle, the detailed structure of target nerve, the effective avoidance of blood vessels, and the diffusion of local anesthetics in real time, which has outstanding advantages. The purpose of this review is to introduce the application of different ultrasound-guided nerve block methods in cardiac surgery analgesia, in order to better perioperative pain management for cardiac surgery patients.
关键词	区域神经阻滞；心脏手术；椎旁神经阻滞；胸肌筋膜间神经阻滞；胸横肌平面阻滞；竖脊肌平面阻滞
KeyWord	Regional nerve block; Heart surgery; Paravertebral nerve block; Pectoral interfascial nerve block; Plane block of transversal thoracic muscle; Erector spinal plane block
基金项目
页码	56-59

参考文献
相关文献

[1] Liu H, Emelife PI, Prabhakar A, Moll V, Kendrick JB, Parr AT, et al. Regional anesthesia considerations for cardiac surgery. Best Pract Res Clin Anaesthesiol. 2019;33:387-406.

[2] Roca J, Valero R, Gomar C. Pain locations in the postoperative period after cardiac surgery: Chronology of pain and response to treatment. Revista Española de Anestesiología y Reanimación (English Edition). 2017;64:391-400.

[3] Choinière M, Watt-Watson J, Victor JC, Baskett RJF, Bussières JS, Carrier M, et al. Prevalence of and risk factors for persistent postoperative nonanginal pain after cardiac surgery: a 2-year prospective multicentre study. Canadian Medical Association Journal. 2014;186:E213-E23.

[4] van Gulik L, Janssen LI, Ahlers SJGM, Bruins P, Driessen AHG, van Boven WJ, et al. Risk factors for chronic thoracic pain after cardiac surgery via sternotomy. European Journal of Cardio-Thoracic Surgery. 2011.

[5] Kleiman AM, Sanders DT, Nemergut EC, Huffmyer JL. Chronic Poststernotomy Pain. Regional Anesthesia and Pain Medicine. 2017;42:698-708.

[6] Noss C, Prusinkiewicz C, Nelson G, Patel PA, Augoustides JG, Gregory AJ. Enhanced Recovery for Cardiac Surgery. Journal of Cardiothoracic and Vascular Anesthesia. 2018;32:2760-70.

[7] Urman RD, Khanna AK, Bergese SD, Buhre W, Wittmann M, Le Guen M, et al. Postoperative opioid administration characteristics associated with opioid-induced respiratory depression: Results from the PRODIGY trial. Journal of Clinical Anesthesia. 2021;70:110167.

[8] Ochroch J, Usman A, Kiefer J, Pulton D, Shah R, Grosh T, et al. Reducing Opioid Use in Patients Undergoing Cardiac Surgery – Preoperative, Intraoperative, and Critical Care Strategies. Journal of Cardiothoracic and Vascular Anesthesia. 2021;35:2155-65.

[9] Shanthanna H, Ladha KS, Kehlet H, Joshi GP. Perioperative Opioid Administration. Anesthesiology. 2020;134:645-59.

[10] Guay J, Kopp S. Epidural analgesia for adults undergoing cardiac surgery with or without cardiopulmonary bypass. Cochrane Database of Systematic Reviews. 2019;2019.

[11] Davies RG, Myles PS, Graham JM. A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy—a systematic review and meta-analysis of randomized trials. British Journal of Anaesthesia. 2006;96:418-26.

[12] Yeung JHY, Gates S, Naidu BV, Wilson MJA, Gao Smith F. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy. Cochrane Database of Systematic Reviews. 2016;2016.

[13] Yalamuri S, Klinger RY, Bullock WM, Glower DD, Bottiger BA, Gadsden JC. Pectoral Fascial (PECS) I and II Blocks as Rescue Analgesia in a Patient Undergoing Minimally Invasive Cardiac Surgery. Regional Anesthesia and Pain Medicine. 2017;42:764-6.

[14] Blanco R, Parras T, McDonnell JG, Prats-Galino A. Serratus plane block: a novel ultrasound-guided thoracic wall nerve block. Anaesthesia. 2013;68:1107-13.

[15] Piracha MM, Thorp SL, Puttanniah V, Gulati A. “A Tale of Two Planes”. Regional Anesthesia and Pain Medicine. 2017;42:259-62.

[16] Kaushal B, Magoon R, Chauhan S, Bhoi D, Bisoi A, Khan M. A randomised controlled comparison of serratus anterior plane, pectoral nerves and intercostal nerve block for post-thoracotomy analgesia in adult cardiac surgery. Indian Journal of Anaesthesia. 2020;64:1018.

[17] Kaushal B, Chauhan S, Saini K, Bhoi D, Bisoi AK, Sangdup T, et al. Comparison of the Efficacy of Ultrasound-Guided Serratus Anterior Plane Block, Pectoral Nerves II Block, and Intercostal Nerve Block for the Management of Postoperative Thoracotomy Pain After Pediatric Cardiac Surgery. Journal of Cardiothoracic and Vascular Anesthesia. 2019;33:418-25.

[18] Ueshima H, Kitamura A. Blocking of Multiple Anterior Branches of Intercostal Nerves (Th2-6) Using a Transversus Thoracic Muscle Plane Block. Regional Anesthesia and Pain Medicine. 2015;40:388.

[19] Zhang Y, Chen S, Gong H, Zhan B. Efficacy of Bilateral Transversus Thoracis Muscle Plane Block in Pediatric Patients Undergoing Open Cardiac Surgery. Journal of Cardiothoracic and Vascular Anesthesia. 2020;34:2430-4.

[20] Fujii S, Roche M, Jones PM, Vissa D, Bainbridge D, Zhou JR. Transversus thoracis muscle plane block in cardiac surgery: a pilot feasibility study. Regional Anesthesia & Pain Medicine. 2019;44:556-60.

[21] Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The Erector Spinae Plane Block: A Novel Analgesic Technique in Thoracic Neuropathic Pain. Reg Anesth Pain Med. 2016;41:621-7.

[22] Adhikary SD, Bernard S, Lopez H, Chin KJ. Erector Spinae Plane Block Versus Retrolaminar Block. Regional Anesthesia and Pain Medicine. 2018:1.

[23] Macaire P, Ho N, Nguyen T, Nguyen B, Vu V, Quach C, et al. Ultrasound-Guided Continuous Thoracic Erector Spinae Plane Block Within an Enhanced Recovery Program Is Associated with Decreased Opioid Consumption and Improved Patient Postoperative Rehabilitation After Open Cardiac Surgery—A Patient-Matched, Controlled Before-and-After Study. Journal of Cardiothoracic and Vascular Anesthesia. 2019;33:1659-67.

[24] Krishna SN, Chauhan S, Bhoi D, Kaushal B, Hasija S, Sangdup T, et al. Bilateral Erector Spinae Plane Block for Acute Post-Surgical Pain in Adult Cardiac Surgical Patients: A Randomized Controlled Trial. Journal of Cardiothoracic and Vascular Anesthesia. 2019;33:368-75.

[25] Athar M, Parveen S, Yadav M, Siddiqui OA, Nasreen F, Ali S, et al. A Randomized Double-Blind Controlled Trial to Assess the Efficacy of Ultrasound-Guided Erector Spinae Plane Block in Cardiac Surgery. Journal of Cardiothoracic and Vascular Anesthesia. 2021;35:3574-80.

[26] Elsabeeny WY, Ibrahim MA, Shehab NN, Mohamed A, Wadod MA. Serratus Anterior Plane Block and Erector Spinae Plane Block Versus Thoracic Epidural Analgesia for Perioperative Thoracotomy Pain Control: A Randomized Controlled Study. Journal of Cardiothoracic and Vascular Anesthesia. 2021;35:2928-36.

引用本文

孙晓璐*. 超声引导下的区域神经阻滞在心脏手术中的应用 [J]. 国际临床研究杂志. 2024; 8; (2). 56 - 59.

文献评论

相关学者

相关机构