Yeying Ge, Liyong Yuan, Yuebo Chen, Yu Zhang, Guangao Ye, Weihu Ma, Liujun Zhao
1 Department of Anesthesiology, Ningbo 6th Hospital, Ningbo 315040, China.
2 Department of Orthopeadic Surgery, Ningbo 6th Hospital, Ningbo 315040, China.
J Int Med Res. 2017 Dec;45(6):2085-2091. doi: 10.1177/0300060517710068. Epub 2017 Jun 21.
Objectives To assess the effect of thoracic paravertebral block (PVB) on pain management and preservation of pulmonary function compared with intravenous, patient-controlled analgesia (IVPCA) in patients with multiple rib fractures (MRFs). Methods Ninety patients with unilateral MRFs were included in this prospective study and randomly assigned to the TPVB or IVPCA group. The visual analogue scale (VAS) pain score, blood gas analysis, and bedside spirometry were measured and recorded at different time points after analgesia. Results TPVB and IVPCA provided good pain relief. VAS scores were significantly lower in the TPVB group than in the IVPCA group at rest and during coughing ( P < 0.05). Patients in the TPVB group had a higher PaO and PaO/FiO and lower PO compared with the IVPCA group ( P < 0.05). Moreover, patients in the TPVB group showed higher FVC, FEV1/FVC, and PEFR, and fewer complications than did the IVPCA group ( P < 0.05). Conclusion TPVB is superior to IVPCA in pain relief and preservation of pulmonary function in patients with MRFs.
评估胸椎旁神经阻滞（PVB）与静脉自控镇痛（IVPCA）相比，对多根肋骨骨折（MRF）患者疼痛管理和肺功能保护的效果。方法：本前瞻性研究纳入90例单侧MRF患者，随机分为胸椎旁神经阻滞组或静脉自控镇痛组。在镇痛后的不同时间点测量并记录视觉模拟量表（VAS）疼痛评分、血气分析和床边肺功能测定结果。结果：胸椎旁神经阻滞和静脉自控镇痛均能有效缓解疼痛。胸椎旁神经阻滞组静息和咳嗽时的VAS评分显著低于静脉自控镇痛组（P < 0.05）。与静脉自控镇痛组相比，胸椎旁神经阻滞组患者的PaO₂和PaO₂/FiO₂更高，而PCO₂更低（P < 0.05）。此外，胸椎旁神经阻滞组患者的用力肺活量（FVC）、第1秒用力呼气容积占用力肺活量比值（FEV₁/FVC）和呼气峰流速（PEFR）更高，并发症也比静脉自控镇痛组更少（P < 0.05）。结论：在多根肋骨骨折患者中，胸椎旁神经阻滞在缓解疼痛和保护肺功能方面优于静脉自控镇痛。
