Sihoe Alan D L, Manlulu Anthony V, Lee Tak-Wai, Thung Kin-Hoi, Yim Anthony P C
Division of Cardiothoracic Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
Eur J Cardiothorac Surg. 2007 Jan;31(1):103-8. doi: 10.1016/j.ejcts.2006.09.035. Epub 2006 Nov 13.
Studies in other surgical specialties have suggested that pre-emptive wound infiltration using a local anesthetic may reduce post-operative pain. We report the first randomized trial to assess the use of pre-emptive local anesthesia in video-assisted thoracic surgery (VATS).
Thirty-one consecutive patients undergoing bilateral needlescopic VATS sympathectomy for palmar hyperhidrosis were studied prospectively. Each patient acted as their own control. For each patient, one side was randomized to receive 10ml 0.5% bupivicaine injected to the port sites before incision, and the contralateral control side to receive 10ml saline. Pain severity on a visual analog scale (VAS) was recorded for each chest side at 4h, 1 day and 7 days following surgery. All patients were blinded to the results of randomization throughout the study.
Follow up was complete for all patients. At 7 days after surgery, wound pain was significantly reduced by pre-emptive local anesthesia, with 10 (62.5%) of the 16 patients having residual pain reporting less pain on the pre-treated side (p=0.039). There was a trend for reduced pain on the pre-treated side at the other time points. Pain reduction by pre-emptive local anesthesia was not correlated with any demographic or clinical variable. Chest wall paresthesia distinct from localized wound pain was noted by six patients (19.4%), but was not reduced by pre-emptive local anesthesia. Overall, the post-operative discomforts felt by the patients after needlescopic VATS were mild, and did not cause significant functional disturbances.
Pre-emptive wound infiltration with a local anesthetic may reduce post-operative wound pain in needlescopic VATS procedures.
其他外科专业的研究表明，使用局部麻醉剂进行超前伤口浸润可能会减轻术后疼痛。我们报告了第一项评估在电视辅助胸腔镜手术（VATS）中使用超前局部麻醉的随机试验。
对31例因手掌多汗症接受双侧针孔VATS交感神经切除术的连续患者进行前瞻性研究。每位患者均作为自身对照。对于每位患者，一侧随机接受在切口前向切口部位注射10ml 0.5%布比卡因，对侧对照侧接受10ml生理盐水。在术后4小时、1天和7天记录每侧胸部的视觉模拟评分（VAS）疼痛严重程度。在整个研究过程中，所有患者对随机分组结果均不知情。
所有患者均完成随访。术后7天，超前局部麻醉显著减轻了伤口疼痛，16例有残留疼痛的患者中有10例（62.5%）报告治疗侧疼痛较轻（p=0.039）。在其他时间点，治疗侧疼痛也有减轻趋势。超前局部麻醉引起的疼痛减轻与任何人口统计学或临床变量均无相关性。6例患者（19.4%）出现了与局部伤口疼痛不同的胸壁感觉异常，但超前局部麻醉并未减轻这种情况。总体而言，患者在针孔VATS术后的不适较轻，未引起明显的功能障碍。
在针孔VATS手术中，使用局部麻醉剂进行超前伤口浸润可能会减轻术后伤口疼痛。
