The effect of ultrasound-guided bilateral thoracic retrolaminar block on analgesia after pediatric open cardiac surgery: a randomized controlled double-blind study

다국어 초록 (Multilingual Abstract)

Background: The thoracic retrolaminar block (TRLB) is a relatively new regional analgesia technique that can be used as an alternative to the thoracic paravertebral block. This study aimed to evaluate the postoperative analgesia effects of ultrasound-guided TRLB in children undergoing open cardiac surgery via median sternotomy incision.Methods: Sixty-six patients aged 2–8 years were recruited. In the TRLB group, 0.25% bupivacaine 0.4 ml/kg was injected into the retrolaminar space on both sides at the level of the T4 lamina. Patients in the control group were injected with 0.9% saline. The primary outcome measure was fentanyl consumption in the first 24 h post-extubation. The secondary outcome measures were the total intraoperative fentanyl consumption, postoperative modified objective pain score (MOPS), and time to extubation.Results: The total intraoperative fentanyl requirements and fentanyl consumption in the first 24 h post-extubation were significantly lower (P < 0.001) in the TRLB group (9.3 ± 1.2; 6.9 ± 2.1 μg/kg, respectively) than in the control group (12.5 ± 1.4; 16.6 ± 2.8, respectively). The median (Q1, Q3) time to extubation was significantly shorter (P < 0.001) in the TRLB group (2 [1, 3] h) than in the control group (6 [4.5, 6] h). The MOPS was significantly lower (P < 0.05) in the TRLB group than in the control group at 0, 2, 4, 8, 12 and 16 h post-extubation.Conclusions: Bilateral ultrasound-guided TRLB is effective in providing postoperative analgesia in children undergoing open cardiac surgery via median sternotomy incision.

참고문헌 (Reference)

1 Wilson GA, "Validation of three paediatric pain scores for use by parents" 51 : 1005-1007, 1996

2 Zeballos JL, "Ultrasound-guided retrolaminar paravertebral block" 68 : 649-651, 2013

3 Alseoudy MM, "Ultrasound-guided retrolaminar block versus ilioinguinal nerve block for postoperative analgesia in children undergoing inguinal herniotomy : a randomized controlled trial" 74 : 110421-, 2021

4 Cakmak M, "Transversus thoracic muscle plane block for analgesia after pediatric cardiac surgery" 35 : 130-136, 2021

5 Damjanovska M, "The ultrasound-guided retrolaminar block : volume-dependent injectate distribution" 11 : 293-299, 2018

6 Voscopoulos C, "The ultrasound-guided retrolaminar block" 60 : 888-895, 2013

7 Jüttner T, "The paravertebral lamina technique : a new regional anesthesia approach for breast surgery" 23 : 443-450, 2011

8 Boo-Young Hwang ; 김은수 ; 권재영 ; Ji-youn Lee ; 이도원 ; Eun Ji Park ; Taewoo Kang, "The analgesic efficacy of a single injection of ultrasound-guided retrolaminar paravertebral block for breast surgery: a prospective, randomized, double-blinded study" 대한통증학회 33 (33): 378-385, 2020

9 Nobukuni K, "Retrolaminar versus epidural block for postoperative analgesia after minor video-assisted thoracic surgery : a retrospective, matched, non-inferiority study" 13 : 2758-2767, 2021

10 Murouchi T, "Retrolaminar block : analgesic efficacy and safety evaluation" 30 : 1003-1007, 2016

11 Terese T. Horlocker, "Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy" BMJ 43 (43): 263-309, 2018

12 Barr LF, "Postoperative multimodal analgesia in cardiac surgery" 36 : 631-651, 2020

13 Lahtinen P, "Pain after cardiac surgery : a prospective cohort study of 1-year incidence and intensity" 105 : 794-800, 2006

14 Bösenberg A, "Neuraxial blockade and cardiac surgery in children" 13 : 559-560, 2003

15 Sotome S, "Erector spinae plane block versus retrolaminar block for postoperative analgesia after breast surgery : a randomized controlled trial" 35 : 27-34, 2021

16 Kaushal B, "Efficacy of bilateral erector spinae plane block in management of acute postoperative surgical pain after pediatric cardiac surgeries through a midline sternotomy" 34 : 981-986, 2020

17 Zhao Y, "Effects of erector spinae plane block and retrolaminar block on analgesia for multiple rib fractures : a randomized, double-blinded clinical trial" 72 : 115-121, 2022

18 Young Hoon Jeon, "Easier and Safer Regional Anesthesia and Peripheral Nerve Block under Ultrasound Guidance" 대한통증학회 29 (29): 1-2, 2016

19 Wang Q, "Comparison of the analgesic effect of ultrasound-guided paravertebral block and ultrasound-guided retrolaminar block in Uniportal video-assisted Thoracoscopic surgery : a prospective, randomized study" 21 : 1229-, 2021

20 Onishi E, "Comparison of clinical efficacy and anatomical investigation between retrolaminar block and erector spinae plane block" 2019 : 2578396-, 2019

21 Macaire P, "Bilateral ultrasound-guided thoracic erector spinae plane blocks using a programmed intermittent bolus improve opioid-sparing postoperative analgesia in pediatric patients after open cardiac surgery : a randomized, double-blind, placebo-controlled trial" 45 : 805-812, 2020

22 Abdelbaser II, "Analgesic efficacy of ultrasound guided bilateral transversus thoracis muscle plane block in pediatric cardiac surgery : a randomized, double-blind, controlled study" 67 : 110002-, 2020

23 Voulgarelis S, "A novel use of liposomal bupivacaine in erector spinae plane block for pediatric congenital cardiac surgery" 2021 : 5521136-, 2021