Department of Thoracic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Medical Quality Management, the Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Ann Thorac Surg. 2018 Sep;106(3):888-894. doi: 10.1016/j.athoracsur.2018.04.036. Epub 2018 May 12.
Paravertebral block (PVB) has been proven to be an efficient way to control postoperative pain in patients who have undergone a thoracotomy. This study explored whether the use of a patient-controlled PVB can provide benefits over intravenous patient-controlled analgesia (PCA) for 3-port single-intercostal video-assisted thoracic surgery.
From May 2015 to December 2016, patients who had solitary pulmonary nodules or spontaneous pneumothorax and underwent single-intercostal video-assisted thoracic surgery were randomly allocated to receive patient-controlled PVB or intravenous PCA. Intramuscular dezocine (10 mg) was used as a rescue medication. None of the surgeons, patients, or investigators assessing outcomes or analyzing the data were blinded to the group assignments. Pain level was measured by the visual analog score.
There were 86 patients assigned to the PVB group and 85 patients assigned to the PCA group. The difference in the mean visual analog score between these two groups was not significant (p = 0.115). For patients who needed rescue medication, the cumulative dezocine dose in the PVB group was significantly lower than that in the PCA group (21.7 mg vs 30.9 mg, p = 0.001) throughout the 4 postoperative days. The frequencies of severe vomiting (p = 0.003) and hypotension (p = 0.005) were significantly lower in the PVB group.
PVB, which resulted in lower cumulative dezocine doses and produced fewer side effects than PCA, can provide effective pain relief for patients undergoing video-assisted thoracic surgery.
椎旁阻滞（PVB）已被证明是控制开胸术后患者术后疼痛的有效方法。本研究探讨了患者自控 PVB 是否优于静脉患者自控镇痛（PCA）用于三切口单肋间电视辅助胸腔镜手术。
2015 年 5 月至 2016 年 12 月，接受单肋间电视辅助胸腔镜手术的患者分为接受患者自控 PVB 或静脉 PCA 组。肌肉注射地佐辛（10 mg）作为解救药物。评估结局或分析数据的外科医生、患者或研究人员均未对分组情况进行盲法。疼痛程度采用视觉模拟评分法测量。
86 例患者被分配到 PVB 组，85 例患者被分配到 PCA 组。两组间平均视觉模拟评分的差异无统计学意义（p=0.115）。对于需要解救药物的患者，PVB 组的地佐辛累积剂量明显低于 PCA 组（21.7 mg 比 30.9 mg，p=0.001），在整个 4 天的术后期间。PVB 组严重呕吐（p=0.003）和低血压（p=0.005）的发生率明显较低。
PVB 与 PCA 相比，地佐辛累积剂量较低，副作用较少，可为接受电视辅助胸腔镜手术的患者提供有效的镇痛。
