Crumley Seamus, Schraag Stefan
Department of Perioperative Medicine, Golden Jubilee National Hospital, Clydebank, UK.
J Thorac Dis. 2018 Mar;10(3):1998-2004. doi: 10.21037/jtd.2018.02.48.
The use of enhanced recovery after surgery (ERAS), as in other surgical specialties, is an emerging concept in cardio-thoracic surgery but there is still a lack of effective protocols to reduce the burden of surgery on the patient, shorten the period of postoperative recovery, and reduce the likelihood of chronic pain developing. The use of local anaesthetic (LA) techniques, such as thoracic epidural analgesia (TEA) and paravertebral blocks (PVB), as an adjunct to anaesthesia are considered key components, though there is little data for direct comparison of the techniques. This review aims to evaluate the role of LA techniques in a thoracic ERAS program through evidence from literature and considering aspects of clinical practice. We discuss how ERAS is adapting and evolving with the increasing use of video-assisted thoracoscopic surgery (VATS) is thoracic surgery. It also examines the advantages of multimodal, opioid-sparing analgesia in the post-operative period to minimise the inflammatory response and improve functional recovery. LA techniques within ERAS protocols have the potential to hasten recovery when managed appropriately and to their full potential.
与其他外科专科一样，术后加速康复（ERAS）在心胸外科仍是一个新兴概念，但目前仍缺乏有效的方案来减轻手术对患者的负担、缩短术后恢复时间并降低慢性疼痛发生的可能性。使用局部麻醉（LA）技术，如胸段硬膜外镇痛（TEA）和椎旁阻滞（PVB）作为麻醉辅助手段，被认为是关键组成部分，不过直接比较这些技术的数据很少。本综述旨在通过文献证据并考虑临床实践方面，评估LA技术在胸科ERAS计划中的作用。我们讨论了随着电视辅助胸腔镜手术（VATS）在胸外科的使用增加，ERAS是如何适应和发展的。它还探讨了多模式、减少阿片类药物使用的镇痛在术后的优势，以尽量减少炎症反应并改善功能恢复。在ERAS方案中，LA技术若得到适当管理并充分发挥其潜力，有可能加速康复。
