From the Department of Anesthesiology and Critical Care, Ehime Prefectural Central Hospital, Ehime, Japan.
Eur J Anaesthesiol. 2019 Apr;36(4):272-278. doi: 10.1097/EJA.0000000000000945.
The analgesic benefits of programmed intermittent bolus infusion for thoracic paravertebral block remain unknown.
The aim of this study was to compare the analgesia from intermittent bolus infusion with that of a continuous infusion after thoracic paravertebral block.
A randomised controlled study.
A single centre between December 2016 and November 2017. Seventy patients scheduled for video-assisted thoracoscopic surgery were included in the study.
INTERVENTION(S): Patients were randomly assigned to receive 0.2% levobupivacaine via continuous infusion (5 ml h, continuous group) or programmed intermittent bolus infusion (15 ml every 3 h, bolus group) after an initial 15-ml bolus injection of 0.2% levobupivacaine.
The main outcome was the amount of rescue fentanyl (per kg of body weight) consumed within 24 h after surgery. Secondary outcomes were postoperative pain scores, plasma levobupivacaine concentrations and the number of dermatomes anaesthetised.
There was no significant difference between the continuous and bolus groups in the postoperative consumption of fentanyl (median [interquartile range] 5.5 [4 to 9.5] μg kg versus 6 [3.5 to 9] μg kg respectively, P = 0.45) and postoperative pain scores within 24 h. At 20 h after initiating the infusions, there was no statistically significant difference between the two groups in terms of the plasma levobupivacaine concentration. The number of dermatomes anaesthetised to pinprick and cold testing was significantly greater in the bolus group.
Our findings suggest that postoperative pain and opioid usage are similar with either programmed intermittent bolus infusion or continuous infusion after thoracic paravertebral block. Programmed intermittent bolus infusion provides a wider sensory blockade and could benefit patients requiring a wider extent of anaesthesia.
UMIN Clinical Trials Registry (UMIN-CTR; URL: http://umin.ac.jp/ctr/, ID: UMIN000023378).
胸椎旁神经阻滞的程控间歇推注镇痛效果尚不清楚。
本研究旨在比较胸椎旁神经阻滞后间歇推注与连续输注的镇痛效果。
随机对照研究。
2016 年 12 月至 2017 年 11 月的单一中心。纳入了 70 例拟行电视辅助胸腔镜手术的患者。
患者随机分为连续输注组（5ml/h，持续输注组）或程控间歇推注组（初始 15ml 0.2%布比卡因推注后，每 3 小时推注 15ml，推注组）。
术后 24 小时内芬太尼（按体重计算）的消耗量。次要观察指标为术后疼痛评分、血浆布比卡因浓度和感觉阻滞的皮区数。
连续输注组和推注组术后芬太尼用量（5.5[4 至 9.5]μg/kg 与 6[3.5 至 9]μg/kg，P=0.45）和术后 24 小时内疼痛评分无显著差异。在输注开始后 20 小时，两组间血浆布比卡因浓度无统计学差异。推注组对刺痛和冷测试的感觉阻滞皮区数明显多于连续输注组。
胸椎旁神经阻滞术后，采用程控间歇推注或连续输注，术后疼痛和阿片类药物使用情况相似。程控间歇推注可提供更广泛的感觉阻滞，可使需要更广泛麻醉范围的患者受益。
UMIN 临床试验注册（UMIN-CTR；网址：http://umin.ac.jp/ctr/，ID：UMIN000023378）。
