Département d'Anesthésie Réanimation, CHU du Bocage, Dijon, France.
Eur J Anaesthesiol. 2012 Nov;29(11):524-30. doi: 10.1097/EJA.0b013e328357e5a1.
Thoracotomy is the surgical procedure that creates the greatest demand for postoperative analgesia.
We aimed to compare the efficacy of systemic analgesia, continuous wound catheter (CWC) analgesia and thoracic paravertebral block (TPVB) for pain management after thoracotomy, assessed by Visual Analogue Scale (VAS) pain score and morphine consumption.
Prospective, randomised study.
University teaching hospital. Inclusions from April 2007 to February 2010.
153 adult patients scheduled for pulmonary surgery.
All three groups received systemic analgesia with paracetamol and morphine (patient-controlled analgesia, PCA). The PCA group received systemic analgesia only. The TPVB group underwent insertion of a paravertebral catheter and the CWC group underwent CWC catheter insertion at the end of the intervention.
Pain score at rest as assessed by VAS.
One hundred and fifty-three patients were included, of whom 140 were included in the final analysis (50 PCA, 44 TPVB, 46 CWC). Baseline and surgical characteristics were comparable in the three groups. VAS scores were statistically different between the TPVB and PCA groups at rest (at 0, 1, 3, 6 h; P < 0.0026) and after coughing (0, 1, 3, 6, 12 h; P < 0.003). In recovery room care, titrated morphine doses were significantly lower (P = 0.00001) in the TPVB group than in the other two. Morphine consumption was statistically lower in the TPVB group than in the PCA group at 24 h (P = 0.0036). There was no difference between CWC and PCA groups in terms of VAS scores or morphine consumption. No signs of toxicity or local complications were observed.
Our results support the efficacy of TPVB for pain management after thoracotomy, at rest and after coughing. These results confirm the preference for TPVB over epidural analgesia in postthoracotomy pain care. CWC failed to decrease pain and morphine consumption and performed no better than placebo.
开胸术是对术后镇痛需求最大的手术程序。
我们旨在比较全身镇痛、连续切口导管（CWC）镇痛和胸椎旁阻滞（TPVB）在开胸术后疼痛管理中的疗效，通过视觉模拟评分（VAS）疼痛评分和吗啡消耗量进行评估。
前瞻性、随机研究。
大学教学医院。纳入时间为 2007 年 4 月至 2010 年 2 月。
153 名计划接受肺手术的成年患者。
所有三组均接受曲马多和吗啡（患者自控镇痛，PCA）全身镇痛。PCA 组仅接受全身镇痛。TPVB 组在干预结束时进行椎旁导管插入，CWC 组进行 CWC 导管插入。
静息时 VAS 评估的疼痛评分。
纳入 153 例患者，其中 140 例纳入最终分析（50 例 PCA，44 例 TPVB，46 例 CWC）。三组的基线和手术特征相似。TPVB 和 PCA 组在静息时（0、1、3、6 h；P < 0.0026）和咳嗽后（0、1、3、6、12 h；P < 0.003）的 VAS 评分存在统计学差异。在恢复室护理中，TPVB 组的吗啡滴定剂量明显低于其他两组（P = 0.00001）。TPVB 组在 24 小时时的吗啡消耗量明显低于 PCA 组（P = 0.0036）。CWC 组与 PCA 组在 VAS 评分或吗啡消耗量方面无差异。未观察到毒性或局部并发症的迹象。
我们的结果支持 TPVB 在开胸术后静息和咳嗽时的镇痛效果。这些结果证实了在开胸术后疼痛治疗中，TPVB 优于硬膜外镇痛。CWC 未能减轻疼痛和吗啡消耗量，且效果并不优于安慰剂。
