Kaya Fatma Nur, Turker Gurkan, Basagan-Mogol Elif, Goren Suna, Bayram Sami, Gebitekin Cengiz
Department of Anesthesiology and Reanimation, Uludag University Medical School, Bursa, Turkey.
J Cardiothorac Vasc Anesth. 2006 Oct;20(5):639-43. doi: 10.1053/j.jvca.2006.03.022. Epub 2006 Aug 8.
The hypothesis was tested that preoperative multiple-injection thoracic paravertebral blocks reduce opioid requirements and promote early ambulation after video-assisted thoracic surgery procedures.
Prospective, randomized, controlled, blinded study.
Single-university hospital.
Fifty consenting patients undergoing video-assisted thoracic surgery.
Patients were randomly assigned to receive preoperative multiple-injection thoracic paravertebral blocks (PVB group, n = 25) or preoperative multiple subcutaneous saline injections at the same site as in the PVB group (control group, n = 25).
Intraoperative fentanyl consumption was lower in the PVB group (p < 0.01). The time to first analgesic requirement was longer, and pain score at this time was lower in the PVB group (p < 0.05 and p < 0.01, respectively). Postoperative pain scores both at rest and coughing were lower during the first 4 hours in the PVB group than those in the control group (p < 0.01 for 0 hours and p < 0.05 for 1, 2, and 4 hours). Cumulative morphine consumption was significantly less in the PVB group at all time points (p < 0.05 for 12 hours and p < 0.01 for all other time points), but there were no significant differences in sedation scores between the 2 groups. There were no complications because of the blocks. Patient satisfaction with the analgesia was significantly greater (p < 0.05), and first mobilization and hospital discharge were quicker (p < 0.01 and p < 0.05, respectively) in the PVB group.
Perioperative multiple-injection thoracic paravertebral blocks with bupivacaine containing epinephrine provided effective pain relief and a significant reduction in opioid requirements. This approach may also contribute to earlier postoperative ambulation after video-assisted thoracic surgery.
检验术前多次注射胸段椎旁阻滞可减少阿片类药物用量并促进电视辅助胸腔镜手术术后早期活动的假设。
前瞻性、随机、对照、双盲研究。
单所大学医院。
50例同意接受电视辅助胸腔镜手术的患者。
患者被随机分配接受术前多次注射胸段椎旁阻滞（椎旁阻滞组，n = 25）或在与椎旁阻滞组相同部位进行术前多次皮下注射生理盐水（对照组，n = 25）。
椎旁阻滞组术中芬太尼用量较低（p < 0.01）。椎旁阻滞组首次需要镇痛的时间较长，此时的疼痛评分较低（分别为p < 0.05和p < 0.01）。在术后最初4小时内，椎旁阻滞组静息和咳嗽时的术后疼痛评分均低于对照组（0小时时p < 0.01，1、2和4小时时p < 0.05）。在所有时间点，椎旁阻滞组的累积吗啡用量均显著较少（12小时时p < 0.05，其他所有时间点p < 0.01），但两组之间的镇静评分无显著差异。未因阻滞出现并发症。椎旁阻滞组患者对镇痛的满意度显著更高（p < 0.05），首次活动和出院时间更快（分别为p < 0.01和p < 0.05）。
围手术期使用含肾上腺素的布比卡因进行多次胸段椎旁阻滞可有效缓解疼痛并显著减少阿片类药物用量。这种方法也可能有助于电视辅助胸腔镜手术后更早地进行术后活动。
