Komatsu Teruya, Sowa Terumasa, Takahashi Koji, Fujinaga Takuji
Department of General Thoracic Surgery, Nagara Medical Center, Gifu, Japan.
Ann Thorac Cardiovasc Surg. 2014;20(2):113-6. doi: 10.5761/atcs.oa.12.01999. Epub 2013 Feb 28.
Analgesia following thoracotomy is routinely accomplished using epidural blockage performed by anesthesiologists. More effective pain control can be achieved with continuous paravertebral blockage performed by thoracic surgeons. We aimed to retrospectively analyze the efficacy of paravertebral blockage for managing post-thoracotomy pain.
The study included 125 patients who underwent continuous paravertebral blockage for the following types of thoracic surgery: video-assisted thoracoscopic surgery(n = 87), anterior axillary thoracotomy (n = 21), posterolateral thoracotomy (n = 16), and median sternotomy with additional left thoracotomy (n = 1). We retrospectively evaluated the analgesic effects of continuous paravertebral blockage by assessing whether a good cough effort could be performed and whether an additional painkiller was given as a rescue medication.
About 115 patients could perform a good cough effort to expectorate sputum immediately after extubation in the operating room. Six patients tolerated postoperative pain well without any oral or rectal non-steroidal anti-inflammatory drugs (NSAIDs). For97 patients postoperative NSAIDs could control thoracotomy pain well. Twenty-two patients were given an additional painkiller stronger than NSAIDs. Three patients complained of nausea postoperatively.
Adequate post-thoracotomy pain control was accomplished by continuous paravertebral blockage, with few complications.
开胸术后镇痛通常由麻醉医生进行硬膜外阻滞来完成。胸外科医生进行连续椎旁阻滞可实现更有效的疼痛控制。我们旨在回顾性分析椎旁阻滞用于管理开胸术后疼痛的疗效。
本研究纳入了125例行连续椎旁阻滞的胸外科手术患者，手术类型包括：电视辅助胸腔镜手术（n = 87）、腋下前开胸术（n = 21）、后外侧开胸术（n = 16）以及正中胸骨切开术加左开胸术（n = 1）。我们通过评估患者能否进行有效的咳嗽以及是否给予额外的止痛药作为解救药物，回顾性地评估连续椎旁阻滞的镇痛效果。
约115例患者在手术室拔管后能立即进行有效的咳嗽以咳出痰液。6例患者在未使用任何口服或直肠非甾体抗炎药（NSAIDs）的情况下，术后疼痛耐受良好。97例患者术后使用NSAIDs能很好地控制开胸术后疼痛。22例患者给予了比NSAIDs更强效的额外止痛药。3例患者术后抱怨恶心。
连续椎旁阻滞可实现充分的开胸术后疼痛控制，且并发症较少。
