Muzuta Mitsuhiko, Beppu Satoru, Hashimoto Soushi, Yoshioka Masami, Matsuo Toshihiro, Ohtsuka Shouji
Department of Anesthesiology, Shin-Koga Hospital, Kurume 830-8577.
Masui. 2004 Mar;53(3):248-51.
We have investigated correlation between postoperative pain and chest tube insertion after video-assisted thoracoscopic surgery (VATS) for patients with spontaneous pneumothorax, and have evaluated preemptive analgesia by intercostal nerve block (ICB) using bupivacaine.
Thirty patients received VATS for spontaneous hemi-pneumothorax. There were two groups of the patients; Group CT received chest tube before the operation, and the Group NCT received no chest tube. Both groups received general anesthesia combined with ICB by 0.25% bupivacaine at the surgical region before operation. Postoperative pain was assessed using visual analogue scale (VAS scale: 0-10) and the need for additional supplemental analgesics before the operation, and at 6 and 24 hours after the operation, and at 3, 7, 14, and 30 days after the operation.
Visual analogue scale in Group NCT before the operation, and at 24 hours, 3, 7, 14, and 30 days after the operation was significantly lower than that of Group CT. Analgesic requirements were significantly lower in the Group NCT than in the Group CT.
We should avoid the insertion of a chest tube before the operation as much as possible. Furthermore early operation and intercostal nerve blockade before the operation were useful to prevent postoperative pain and its shift to chronic post thoracostomy pain.
我们研究了电视辅助胸腔镜手术（VATS）治疗自发性气胸患者术后疼痛与胸腔闭式引流管置入之间的相关性，并评估了使用布比卡因进行肋间神经阻滞（ICB）的超前镇痛效果。
30例患者接受VATS治疗自发性单侧气胸。患者分为两组；CT组在手术前放置胸腔闭式引流管，NCT组未放置胸腔闭式引流管。两组均在手术前接受全身麻醉并在手术区域使用0.25%布比卡因进行肋间神经阻滞。使用视觉模拟量表（VAS量表：0 - 10）评估术前、术后6小时、24小时以及术后3天、7天、14天和30天的术后疼痛情况以及额外补充镇痛药的需求。
NCT组术前、术后24小时、3天、7天、14天和30天的视觉模拟量表评分显著低于CT组。NCT组的镇痛需求显著低于CT组。
我们应尽可能避免在手术前放置胸腔闭式引流管。此外，早期手术和术前肋间神经阻滞有助于预防术后疼痛及其向慢性开胸术后疼痛的转变。
