RESUMEN
Objective: The present study was performed to evaluate the effect of ultrasound-guided erector spinae plane block (ESPB) on pain after laparoscopic transabdominal preperitoneal (TAPP) repair. Therefore, improved postoperative pain management is crucial for enhancing the overall patient experience and recovery. Methods: This prospective, double-blind, randomized controlled trial enrolled 40 male patients with a unilateral inguinal hernia at Xi'an Aerospace General Hospital from November 1, 2020, to February 1, 2021. Participants were assigned through a random number table at a 1:1 ratio to receive either ESPB with 20 ml 0.5% ropivacaine in the experimental group (Group E) or ESPB with 20 ml normal saline in the control group (Group C), with 20 cases in each group. The primary outcome was assessed using visual analogue scale (VAS) scores for exercise pain at 2h, 6h, 12h, 18h, and 24h postoperatively. Secondary outcomes included time lapses before patient-controlled intravenous analgesia (PCIA) use, intraoperative remifentanil usage, additional sufentanil, postoperative nalbuphine consumption, analgesic remedies at 24h postoperatively, and incidence of postoperative adverse events. Results: Group E provided more pain mitigation for patients than Group C, as evidenced by the significantly lower VAS scores during exercise pain at 2h (Group C: 1.95±1.19; Group E:4.00±1.38), 6h (Group C: 2.00±1.12; Group E:3.90±1.37), and 12h (Group C: 2.05±1.05; Group E:3.55±1.36) postoperatively (P < .05), and the pain mitigation for Group C was significant only at 18h and 24h postoperatively compared to at 2h postoperatively (P < .05). Group E resulted in significantly reduced intraoperative use of remifentanil and, additional sufentanil and postoperative nalbuphine consumption versus Group C (P < .05). Group E exhibited a better pain tolerance than Group C, as demonstrated by the longer time lapse before the use of PCIA (RR value=5.709, t=8.446, P < .05). Group C required more analgesic remedies within 24 h after surgery than Group E (P < .05). Group E did not increase the risk of postoperative adverse events, given the absence of statistical significance in the intergroup comparison (P > .05). Conclusion: Ultrasound-guided ESPB demonstrates notable benefits by decreasing intraoperative and postoperative anesthetic drug requirements, enhancing pain management, and elevating postoperative comfort and quality of life for patients. While acknowledging the study's limitations, it is crucial to highlight the potential clinical implications of these findings. The incorporation of ESPB with ropivacaine into postoperative pain management protocols could represent a significant advancement in clinical practice. The observed improvements in pain management and reduced reliance on anesthetic drugs may lead to more tailored and efficient postoperative care, potentially enhancing patient recovery experiences. Further research and practical implementation studies are warranted to fully elucidate the specific impact and optimal integration of ESPB with ropivacaine within broader clinical settings.
RESUMEN
BACKGROUND: This investigation aimed to evaluate the impact of continuous pericapsular nerve group (PENG) block and continuous fascia iliac compartment block (FICB) on postoperative pain following total hip arthroplasty (THA). METHODS: This prospective, randomized, and controlled trial recruited a cohort of fifty-seven patients with unilateral femoral neck fractures from Xi'an Aerospace General Hospital in northwest China between July 2020 and November 2021. These patients were randomly assigned to two groups: the continuous PENG block group (PENG group, n = 29) and the continuous FICB group (FICB group, n = 28). Under ultrasound guidance, PENG block and FICB procedures were performed prior to spinal anesthesia, utilizing 20 ml of 0.25% ropivacaine for PENG block and 30 ml of 0.25% ropivacaine for FICB. Subsequently, a catheter was inserted. All study participants received a standardized postoperative multimodal analgesic regimen, including intravenous administration of 30 mg Ketorolac tromethamine every eight hours and patient-controlled neural analgesia (PCNA) after surgery. Numerical rating scale (NRS) scores at rest and during exercise were recorded at various time points: prior to block (T0), 30 min post-blockade (T1), and 6 h (T2), 12 h (T3), 24 h (T4), and 48 h (T5) postoperatively. Additional data collected encompassed postoperative quadriceps muscle strength, the time of initial ambulation after surgery, the number of effective PCNA activations, rescue analgesia requirements, and occurrences of adverse events (such as nausea and vomiting, hematoma, infection, catheter detachment, or displacement) within 48 h following surgery. RESULTS: In the PENG group, the resting NRS pain scores exhibited lower values at T1, T4, and T5 than those at T0. Furthermore, exercise NRS pain scores at T1-T5 were lower in the PENG group than in the FICB group. Similarly, during the same postoperative period, the PENG group demonstrated enhanced quadriceps strength on the affected side compared to the FICB group. Additionally, the PENG group displayed earlier postoperative ambulation and reduced occurrences of effective PCNA activations and rescue analgesia requirements compared to the FICB group. CONCLUSION: Continuous PENG block exhibited superior analgesic efficacy after THA compared to continuous FICB, promoting recovery of quadriceps strength on the affected side and facilitating early postoperative ambulation. TRIAL REGISTRATION: This clinical trial was registered in the China Clinical Trials Center ( http://www.chictr.org.cn ) on 20/07/2020, with the registration number ChiCTR2000034821.