Alzahrani Tariq
Department of Anesthesia, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Saudi J Anaesth. 2017 Jul-Sep;11(3):327-331. doi: 10.4103/sja.SJA_39_17.
Thoracic surgical procedures can be either thoracotomy or thoracoscopy. In thoracotomy, the incision could be either muscle-cutting or muscle-sparing incision. The posterolateral thoracotomy incision is used for most general thoracic surgical procedures. This incision, which involves division of the latissimus dorsi and serratus anterior muscles, affords excellent exposure of the thoracic cavity. However, it is associated with significant morbidity, including impaired pulmonary function, postoperative chest pain, and restricted arm and shoulder movement. Various muscle-sparing incisions have been proposed to decrease the morbidity. Postthoracotomy pain originates from pleural and muscular damage, costovertebral joint disruption, and intercostal nerve damage during surgery. Inadequate pain relief after surgery affects the quality of patient's recovery and exposes the patients to postoperative morbidities. There is a tendency nowadays among thoracic surgeons and anesthesiologists toward the area of enhanced recovery after thoracic surgery which requires careful titration of the anesthetic drugs in awake patients undergoing thoracoscopic procedures. There is a common feeling among thoracic anesthesiologists that potthoracoscopy procedures produce less pain intensity versus thoracotomy which is partially true. However, effective management of acute pain following either thoracotomy/thoracoscopy is needed and may prevent these complications and reduce the likelihood of developing chronic pain. In this report, we are going to review the newly introduced postthoracotomy/thoracoscopy pain relief modalities with special reference to the new tendency of awake thoracic surgical procedures and its impact on enhanced recovery after surgery.
胸外科手术可采用开胸手术或胸腔镜手术。在开胸手术中，切口可以是肌肉切开切口或肌肉保留切口。后外侧开胸切口用于大多数普通胸外科手术。该切口需要切断背阔肌和前锯肌，能很好地暴露胸腔。然而，它会带来显著的并发症，包括肺功能受损、术后胸痛以及手臂和肩部活动受限。人们提出了各种肌肉保留切口以降低并发症发生率。开胸术后疼痛源于手术过程中的胸膜和肌肉损伤、肋椎关节破坏以及肋间神经损伤。术后疼痛控制不佳会影响患者的恢复质量，并使患者面临术后并发症。如今，胸外科医生和麻醉医生倾向于关注胸外科手术后的加速康复领域，这需要对接受胸腔镜手术的清醒患者仔细调整麻醉药物剂量。胸科麻醉医生普遍认为，与开胸手术相比，胸腔镜手术产生的疼痛强度较小，这有一定道理。然而，需要对开胸手术/胸腔镜手术后的急性疼痛进行有效管理，这可能预防这些并发症并降低发生慢性疼痛的可能性。在本报告中，我们将回顾新引入的开胸手术/胸腔镜手术后疼痛缓解方式，特别提及清醒胸外科手术的新趋势及其对术后加速康复的影响。
