Anaesthetic Department, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK.
Anaesthesia. 2018 Apr;73(4):444-449. doi: 10.1111/anae.14205. Epub 2018 Jan 12.
It is not known which regional analgesic technique is most effective or safest after open lung resection. We retrospectively examined outcomes in 828 patients who received thoracic epidural analgesia and 791 patients who received paravertebral block after lung resection between 2008 and 2012. We analysed outcomes for 648 patients, 324 who had each analgesic technique, matched by propensity scores generated with peri-operative data. There were 22 out of 324 (7%) postoperative respiratory complications after thoracic epidural and 23 out of 324 (7%) after paravertebral block, p = 0.88. For any postoperative complication, there were 80 out of 324 (25%) and 78 out of 324 (24%) complications, respectively, p = 0.85. There were 17 out of 324 (5%) re-admissions to intensive care after thoracic epidural and 17 out of 324 (5%) after paravertebral block, p > 0.99, and the number of deaths before discharge were 6 out of 324 (2%) and 4 out of 324 (1%), respectively, p = 0.53. There was no significant difference in median (IQR [range]) hospital stay after thoracic epidural or paravertebral block, 6 (5-9 [2-94]) days vs. 6 (5-9 [2-122]), respectively, p = 0.83. Our study suggests that rates of complications as well as length of hospital stay after thoracic epidural analgesia and paravertebral blockade are similar. We were unable to compare analgesic efficacy due to incomplete data.
尚不清楚开胸肺切除术后哪种局部镇痛技术最有效或最安全。我们回顾性分析了 2008 年至 2012 年间 828 例接受胸段硬膜外镇痛和 791 例接受椎旁阻滞的患者的结局。我们分析了 648 例患者的结局，其中 324 例患者分别接受了这两种镇痛技术，并根据围手术期数据生成的倾向评分进行了匹配。胸段硬膜外镇痛后有 22 例（7%）和椎旁阻滞后有 23 例（7%）发生术后呼吸并发症，p = 0.88。任何术后并发症，胸段硬膜外组有 80 例（25%），椎旁阻滞组有 78 例（24%），p = 0.85。胸段硬膜外组有 17 例（5%）和椎旁阻滞组有 17 例（5%）需要再次入住重症监护病房，p > 0.99，出院前死亡人数分别为 6 例（2%）和 4 例（1%），p = 0.53。胸段硬膜外和椎旁阻滞的中位（IQR [范围]）住院时间分别为 6（5-9 [2-94]）天和 6（5-9 [2-122]）天，p = 0.83。我们的研究表明，胸段硬膜外镇痛和椎旁阻滞的并发症发生率和住院时间相似。由于数据不完整，我们无法比较镇痛效果。
