Karnik Priyanka Pradeep, Dave Nandini Malay, Garasia Madhu
Department of Anesthesiology, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India.
Saudi J Anaesth. 2018 Apr-Jun;12(2):240-244. doi: 10.4103/sja.SJA_659_17.
The stripping of the densely innervated and inflamed parietal pleura in empyema during video-assisted thoracoscopic surgery (VATS) decortication can lead to significant pain and major postoperative respiratory compromise. Hence, we compared the analgesic efficacy of continuous epidural infusion versus local infiltration and systemic opioids in children undergoing VATS decortications.
Following ethics approval and informed consent, forty patients from 1 to 12 years of age were randomized into two groups, Group E (epidural) and Group L (local infiltration) after induction of anesthesia. In Group E, a thoracic epidural catheter was inserted between T4 and T8. A bolus dose of 0.5 ml/kg of 0.25% injection bupivacaine was given epidurally before incision. Postoperatively, the patients received epidural infusion with bupivacaine and fentanyl up to 48 h using an elastomeric balloon pump. In Group L, patients received local infiltration of bupivacaine (2 mg/kg) and lignocaine (5 mg/kg) at the port sites before incision and at the end of surgery. They also received injection tramadol 1 mg/kg intravenously TDS with thrice daily postoperatively. The pain scores (Face, Legs, Activity, Cry, Consolability/ Wong-Baker FACES scale) were assessed every 4 h on the 1 day and 6 h on the 2 day. Injection diclofenac 1 mg/kg intravenous was used as a rescue analgesic for pain scores more than 4. Side effects such as nausea, vomiting, constipation, and motor blockade were noted. Quantitative and categorical data were assessed using -test and Chi-square test, respectively.
The pain scores were lower in the epidural group than in the local infiltration group at 0, 4, and 20 h postoperatively ( = 0.001, 0.01, and 0.038, respectively). Seventeen out of nineteen patients required rescue analgesia in the local infiltration group in the postoperative period as compared to five patients in the epidural group with a value of 0.000081.
Epidural analgesia can be considered as an effective modality of reducing pain in patients undergoing VATS decortication for empyema in pediatric patients.
在电视辅助胸腔镜手术（VATS）纤维板剥脱术中，剥除脓胸时神经密集且发炎的壁层胸膜会导致严重疼痛和术后严重的呼吸功能障碍。因此，我们比较了持续硬膜外输注与局部浸润及全身性阿片类药物在接受VATS纤维板剥脱术的儿童中的镇痛效果。
在获得伦理批准并取得知情同意后，40名1至12岁的患者在麻醉诱导后被随机分为两组，E组（硬膜外组）和L组（局部浸润组）。在E组中，在T4和T8之间插入胸段硬膜外导管。在切开前硬膜外给予0.25%布比卡因注射液0.5 ml/kg的推注剂量。术后，患者使用弹性球囊泵接受布比卡因和芬太尼的硬膜外输注，持续48小时。在L组中，患者在切开前和手术结束时在切口部位接受布比卡因（2 mg/kg）和利多卡因（5 mg/kg）的局部浸润。他们还在术后每天静脉注射曲马多1 mg/kg，每日三次。在术后第1天每4小时和第2天每6小时评估疼痛评分（面部、腿部、活动、哭闹、安慰/面部表情评分量表）。对于疼痛评分超过4分的情况，使用双氯芬酸1 mg/kg静脉注射作为急救镇痛药。记录恶心、呕吐、便秘和运动阻滞等副作用。分别使用t检验和卡方检验评估定量和分类数据。
术后0、4和20小时，硬膜外组的疼痛评分低于局部浸润组（分别为P = 0.001、0.01和0.038）。术后期间，局部浸润组19名患者中有17名需要急救镇痛，而硬膜外组有5名患者，P值为0.000081。
硬膜外镇痛可被视为减轻小儿脓胸患者接受VATS纤维板剥脱术时疼痛的有效方式。
