rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2023-3-39-45rmt-2300Research ArticleПРАКТИКУЮЩЕМУ ВРАЧУFOR PRACTIONERЭффективность продленной блокады фасциальной плоскости мышцы, выпрямляющей спину, при множественных переломах реберThe Analgesic Efficacy of Prolonged Erector Spinae Fascial Plane Block in Patients with Multiple Rib Fractureshttps://orcid.org/0000-0003-2517-1183ШариповаВ. Х.SharipovaV. H.

Висолат Хамзаевна Шарипова

 Республика Узбекистан, 100115 г. Ташкент, Чиланзарский район, ул. Фархад, д. 2 

 Visolat H. Sharipova 

 2 Farhad Str., Chilanzar district, 100115 Tashkent, Republic of Uzbekistan 

visolat_78@mail.ruhttps://orcid.org/0000-0002-5204-3390ФокинИ. В.FokinI. V.

Иван Викторович Фокин, зав операционно-анестезиологического отделения 

 Республика Узбекистан, 100115 г. Ташкент, Чиланзарский район, ул. Фархад, д. 2 

 Ivan V. Fokin 

 2 Farhad Str., Chilanzar district, 100115 Tashkent, Republic of Uzbekistan 

vafanya3@yandex.ruРеспубликанский научный центр экстренной медицинской помощиУзбекистанRepublican Research Centre of Emergency MedicineUzbekistan2023230620231933945Copyright © Шарипова В.Х., Фокин И.В., 20232023Шарипова В.Х., Фокин И.В.Sharipova V.H., Fokin I.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.reanimatology.com/rmt/article/view/2300

Цель исследования. Оценить эффективность продленной блокады фасциальной плоскости мышцы, выпрямляющей спину, у пациентов с множественными переломами ребер.Материал и методы. В исследование включили 40 больных с множественными переломами ребер. В зависимости от способа обезболивания переломов ребер больных разделили на 2 группы, где в контрольной группе (n=20) обезболивание проводили системными анальгетиками, а в основной группе (n=20), помимо системных анальгетиков, обезболивание дополняли продленной блокадой мышцы, выпрямляющей спину, в фасциальной плоскости. Измеряли выраженность боли по цифровой рейтинговой шкале боли (ЦРШ) в покое и при кашле, форсированную жизненную емкость легких, потребность в инъекционных наркотических анальгетиках.Результаты. Показатель ЦРШ в покое в основной группе был статистически значимо выше по сравнению с контрольной группой: на II этапе — 1,5 балла (IQR: 1,0–3,0) против 3,0 баллов (IQR: 3,0–4,0); на III этапе — 2,0 балла (IQR: 1,0–2,0) против 4,0 баллов (IQR: 3,0–5,0); на IV этапе — 1,5 балла (IQR: 0,8–2,2) против 4,5 баллов (IQR: 4,0–5,0); на V этапе — 1 балл (IQR: 0–2,0) против 3,0 баллов (IQR: 2,8–4,0), соответственно (p0,001). Показатель ФЖЕЛ в контрольной группе в процентном соотношении, в зависимости от должной по полу, возрасту, росту и весу пациента, составил на II этапе — 38±8% (95%CI: 34–41); III этапе — 44±8% (95%CI: 40–47); IV этапе — 41±10% (95%CI: 36–45) и V этапе — 49±10 % (95%CI: 45–53). В основной группе ФЖЕЛ составил на II этапе — 49±15% (95%CI: 42–56), III этапе — 50±13% (95%CI: 44–57), IV этапе 53±13% (95%CI: 47–59) и V этапе 57±11% (95%CI: 52–63), что, соответственно, было на 22%, 14%, 24% и 15% статистически значимо меньше, чем в основной группе (p0,05). Потребление наркотических анальгетиков в 1-е и 2-е сутки после начала исследования в основной группе составило 5,0 мг (IQR: 5–10) и 5,0 мг (IQR: 0–5,0) против 10,0 мг (IQR: 5,0–15,0) и 7,5 мг (IQR: 5,0–10,0) в контрольной группе, соответственно (p0,05).Заключение. Продленная блокада фасциальной плоскости мышцы, выпрямляющей спину, улучшает качество обезболивания и увеличивает показатели ФЖЕЛ у больных с множественными переломами ребер.

Objctive. To evaluate the analgesic efficacy of prolonged erector spinae fascial plane (ESFP) block in patients with multiple rib fractures.Material and methods. The study included 40 patients with multiple rib fractures. Based on anesthesia methods, patients were divided into 2 groups, where systemic analgesics were used for pain management in the control group (N=20), and additional supplementation with prolonged erector spinae fascial plane (ESFP) block in the main group (N=20). The study monitored the severity of pain measured by the numeric rating scale (NRS) at rest and during coughing, forced vital capacity (FVC), and the need for injectable narcotic analgesics.Results. The NRS measures at rest in the main group were statistically significantly superior to the control group results: at stage II — 1.5 points (IQR: 1.0–3.0) vs 3.0 points (IQR: 3.0–4.0); at stage III — 2.0 points (IQR: 1.0–2.0) vs 4.0 points (IQR: 3.0–5.0); at stage IV — 1.5 points (IQR: 0.8–2.2) vs. 4.5 points (IQR: 4.0–5.0); at stage V — 1 point (IQR: 0–2,0) vs. 3.0 points (IQR: 2.8–4.0), respectively (P0.001). Percentages of predicted FVC depending on patient’s gender, age, height and weight in the control group were as follows: at stage II — 38± 8% (95%CI: 34–41); stage III — 44± 8% (95%CI: 40–47); stage IV — 41±10% (95%CI: 36–45) and stage V — 49±10% (95%CI: 45–53). In the main group, the following FVC values were obtained: 49±15% at stage II (95%CI: 42–56), 50±13% at stage III (95%CI: 44–57), 53±13% at stage IV (95%CI: 47–59), and 57±11% at stage V (95%CI: 52–63). Therefore, statistically significant FVC reduction in the control group vs the main group came up to 22%, 14%, 24% and 15% at stages II-V, respectively (P0.05). The amounts of injected narcotic analgesics on day 1 and day 2 after initiation of the study were 5.0 mg (IQR: 5–10) and 5.0 mg (IQR: 0–5.0) in the main group vs 10.0 mg (IQR: 5.0–15.0) and 7.5 mg (IQR: 5.0–10.0) in the control group, respectively (P0.05).Conclusion. The prolonged erector spinae fascial plane block improves the quality of analgesia and FVC values in patients with multiple rib fractures.

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The authors declare that there are no conflicts of interest present.