Fentie Demeke Yilkal, Gebremedhn Endale Gebreegziabher, Denu Zewditu Abdissa, Gebreegzi Amare Hailekiros
Department of Anesthesia, School of Medicine, Gondar College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Local Reg Anesth. 2017 Jul 10;10:67-74. doi: 10.2147/LRA.S133946. eCollection 2017.
Cholecystectomy can be associated with considerable postoperative pain. While the benefits of paravertebral block (PVB) on pain after thoracotomy and mastectomy have been demonstrated, not enough investigations on the effects of PVB on pain after open cholecystectomy have been conducted. We tested the hypothesis that a single-injection thoracic PVB reduces pain scores, decreases opioid consumption, and prolongs analgesic request time after cholecystectomy.
Of 52 patients recruited, 50 completed the study. They were randomly allocated into two groups: the paravertebral group and the control group. The outcome measures were the severity of pain measured on numeric pain rating scale, total opioid consumption, and first analgesic request time during the first postoperative 24 hours.
The main outcomes recorded during 24 hours after surgery were Numerical Rating Scale (NRS) pain scores (NRS, 0-10), cumulative opioid consumption, and the first analgesic request time. Twenty four hours after surgery, NRS at rest was 4 (3-6) vs 5 (5-7) and at movement 4 (4-7) vs 6 (5-7.5) for the PVB and control groups, respectively. The difference between the groups over the whole observation period was statistically significant (<0.05). Twenty-four hours after surgery, median (25th-75th percentile) cumulative morphine consumption was 0 (0-2) vs 2.5 (2-4) mg (<0.0001) and cumulative tramadol consumption was 200 (150-250) mg vs 300 (200-350) mg in the paravertebral and in the control group, respectively (=0.003). After surgery, the median (25th-75th percentile) first analgesic requirement time was prolonged in the PVB group in statistically significant fashion (<0.0001).
Single-shot thoracic PVB as a component of multi-modal analgesic regimen provided superior analgesia when compared with the control group up to 24 postoperative hours after cholecystectomy, and we recommend this block for post cholecystectomy pain relief.
胆囊切除术可能伴有相当程度的术后疼痛。虽然椎旁阻滞（PVB）对开胸手术和乳房切除术后疼痛的益处已得到证实，但对PVB对开腹胆囊切除术后疼痛影响的研究还不够充分。我们检验了这样一个假设，即单次注射胸段PVB可降低疼痛评分、减少阿片类药物用量并延长胆囊切除术后的镇痛需求时间。
在招募的52例患者中，50例完成了研究。他们被随机分为两组：椎旁阻滞组和对照组。观察指标为术后24小时内用数字疼痛评分量表测量的疼痛严重程度、阿片类药物总用量以及首次镇痛需求时间。
术后24小时记录的主要观察指标为数字评分量表（NRS）疼痛评分（NRS，0 - 10）、阿片类药物累积用量以及首次镇痛需求时间。术后24小时，PVB组和对照组静息时NRS分别为4（3 - 6）和5（5 - 7），活动时分别为4（4 - 7）和6（5 - 7.5）。两组在整个观察期内的差异具有统计学意义（<0.05）。术后24小时，PVB组和对照组吗啡累积用量中位数（第25 - 75百分位数）分别为0（0 - 2）mg和2.5（2 - 4）mg（<0.0001），曲马多累积用量分别为200（150 - 250）mg和300（200 - 350）mg（=0.003）。术后，PVB组首次镇痛需求时间中位数（第25 - 75百分位数）延长，差异具有统计学意义（<0.0001）。
单次胸段PVB作为多模式镇痛方案的一部分，与对照组相比，在胆囊切除术后24小时内提供了更好的镇痛效果，我们推荐采用这种阻滞方法缓解胆囊切除术后疼痛。
