Larsson Mark, Öwall Anders, Sartipy Ulrik, Franco-Cereceda Anders, Johansson Barbro, Jakobsson Jan G
Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
Function Perioperative Medicine and Intensive Care, Section for Cardiothoracic Anaesthesia and Intensive Care, Karolinska University Hospital, Stockholm, 17176, Sweden.
F1000Res. 2018 Nov 12;7:1783. doi: 10.12688/f1000research.16857.1. eCollection 2018.
Video-assisted thoracoscopic surgery (VATS) causes less postoperative pain than thoracotomy; however, adequate analgesia remains vital. As part of a multi-modal postoperative analgesia, a continuous surgeon-placed extrapleural block catheter is an option. The aim of this retrospective study was to evaluate the analgesic efficacy of a continuous extrapleural block as part of a multimodal analgesic regimen after VATS in general, and VATS lobectomy and wedge resection in particular. Case records for patients having undergone VATS surgery and been provided a multi-level continuous extrapleural block with an elastomeric pump infusing levobupivacaine 2.7 mg/ml at a rate of 5 ml/h during 2015 and 2016 were reviewed. Pain (Numeric Rating Scale) at rest and mobilisation as well as opioid requirement (daily, postoperative days 0-3, as well as accumulated) were analysed. In all, 454 records were reviewed: 150 wedge resections, 264 lobectomies and 40 miscellaneous cases. At rest, pain was mild median NRS rated 3-3-1-1 for postoperative day (POD) 0 to 3, during movement, pain was rated moderate during POD 0 and 1 and mild the remaining days (median NRS 4-4-3-3 for POD 0-3). The proportion of patients exhibiting mild pain at rest increased from 55% on POD 0 to 81 % on POD 3. The percentage of patients experiencing severe pain at rest decreased from 15% to 6%. Median oxycodone consumption was 10 mg per day for POD 1-3. Pain after VATS wedge resection was significantly lower at POD 1 and 3 compared to pain after VATS lobectomy. We found a continuous surgeon-placed extrapleural catheter block to be a valuable and seemingly safe addition to our multimodal procedure specific analgesia after VATS. Whether the efficacy of the block can be improved by increasing local anaesthetic and/or adding adjuncts warrants further investigation.
电视辅助胸腔镜手术（VATS）术后疼痛比开胸手术轻；然而，充分的镇痛仍然至关重要。作为多模式术后镇痛的一部分，外科医生放置连续的胸膜外阻滞导管是一种选择。这项回顾性研究的目的是评估连续胸膜外阻滞作为VATS术后多模式镇痛方案一部分的镇痛效果，特别是VATS肺叶切除术和楔形切除术的镇痛效果。回顾了2015年至2016年期间接受VATS手术并通过弹性泵以5 ml/h的速度输注2.7 mg/ml左旋布比卡因进行多平面连续胸膜外阻滞的患者的病例记录。分析了静息和活动时的疼痛（数字评分量表）以及阿片类药物需求量（术后第0至3天每日及累计量）。
总共回顾了454份记录：150例楔形切除术、264例肺叶切除术和40例其他病例。静息时，术后第0至3天疼痛轻微，数字评分量表中位数为3-3-1-1；活动时，术后第0天和第1天疼痛为中度，其余天数为轻度（术后第0至3天数字评分量表中位数为4-4-3-3）。静息时表现为轻度疼痛的患者比例从术后第0天的55%增加到术后第3天的81%。静息时经历重度疼痛的患者比例从15%降至6%。术后第1至3天羟考酮的中位消耗量为每日10 mg。与VATS肺叶切除术后的疼痛相比，VATS楔形切除术后第1天和第3天的疼痛明显更低。我们发现外科医生放置的连续胸膜外导管阻滞是VATS术后多模式特定镇痛的一种有价值且看似安全的补充。通过增加局部麻醉药和/或添加辅助药物是否能提高阻滞效果值得进一步研究。
