Rhomboid intercostal block with subserratus plane block in bariatric surgery: a three-arm prospective randomized comparative study

Background and objectivesBariatric surgery is an effective intervention for managing obesity, yet postoperative pain management remains a significant challenge. Standard analgesic techniques such as patient-controlled analgesia (PCA) and continuous epidural analgesia (CEA) are effective but associated with considerable side effects, including nausea, hypotension, and respiratory depression. This study aimed to evaluate the efficacy and safety of the rhomboid intercostal block combined with subserratus plane block (RISS) compared to PCA and CEA for postoperative analgesia in bariatric surgery.MethodsA prospective randomized comparative study was conducted, enrolling 144 patients undergoing elective bariatric surgery. Participants were randomized into three groups: PCA, CEA, and RISS. Pain scores (numerical rating scale, NRS) at rest and during movement, opioid consumption, and side effects were assessed at 4, 8, 12, and 24 hours postoperatively. Statistical analyses included one-way ANOVA and repeated-measures ANOVA to evaluate the efficacy and non-inferiority of RISS compared to PCA and CEA.ResultsIntraoperatively, the ephedrine dosage (mg) in the PCA and RISS groups was significantly lower than that in the CEA group (P = 0.0003). RISS provided comparable analgesic efficacy to CEA. At 12 hours postoperatively, rest pain scores (NRS) were 3.7 ± 0.4 in the PCA group, 2.7 ± 0.3 in the CEA group, and 2.3 ± 0.3 in the RISS group (P ConclusionRISS is a safe and effective postoperative analgesic technique for bariatric surgery, achieving pain relief comparable to CEA but with fewer side effects, and demonstrating superior outcomes compared to PCA. This study supports the adoption of RISS in clinical practice to enhance postoperative pain management and patient recovery in bariatric surgery.研究背景与目的 减重手术是管理肥胖症的有效干预手段，但术后疼痛管理仍是一项亟待解决的重大临床难题。诸如患者自控镇痛（Patient-Controlled Analgesia, PCA）、持续硬膜外镇痛（Continuous Epidural Analgesia, CEA）等标准镇痛技术虽具有确切疗效，但常伴随恶心、低血压、呼吸抑制等显著不良反应。本研究旨在评估菱形肌肋间阻滞联合前锯肌下平面阻滞（Rhomboid Intercostal Block combined with Subserratus Plane Block, RISS）对比PCA与CEA用于减重手术术后镇痛的有效性与安全性。 研究方法 本研究为前瞻性随机对照比较研究，共纳入144例拟接受择期减重手术的患者，按随机原则分为PCA组、CEA组与RISS组。分别于术后4、8、12及24小时评估患者静息状态与活动状态下的疼痛评分（数字评定量表，Numerical Rating Scale, NRS）、阿片类药物（opioid）消耗量及不良反应发生情况。统计分析采用单因素方差分析（one-way ANOVA）与重复测量方差分析（repeated-measures ANOVA），以评估RISS对比PCA与CEA的镇痛有效性及非劣效性。 研究结果 术中，PCA组与RISS组的麻黄碱（ephedrine）使用剂量（mg）显著低于CEA组（P = 0.0003）。RISS的镇痛疗效与CEA相当。术后12小时时，PCA组静息疼痛评分（NRS）为3.7±0.4，CEA组为2.7±0.3，RISS组为2.3±0.3（P 研究结论 RISS是一种安全有效的减重手术术后镇痛技术，其镇痛效果与CEA相当，但不良反应发生率更低，且疗效优于PCA。本研究支持在临床实践中推广应用RISS，以优化减重手术的术后疼痛管理，加速患者术后康复。