Department of Anesthesiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road 79, Hangzhou 31003, China.
Department of Anesthesiology, Hangzhou Red Cross Hospital, East Road 208, Hangzhou 31003, China.
Pain Res Manag. 2019 Nov 18;2019:9158653. doi: 10.1155/2019/9158653. eCollection 2019.
Despite being less invasive, patients who underwent video-assisted thoracic surgery (VATS) suffered considerable postoperative pain. Paravertebral block (PVB) was proven to provide effective analgesia in patients with VATS; however, there is no difference in pain relief between preoperative PVB and postoperative PVB. This study was aimed to investigate the analgesic efficacy of combination of preoperative and postoperative PVB on the same patient undergoing VATS. In this prospective, double-blinded, randomized controlled trial, 44 patients undergoing VATS were enrolled, and they received patient-controlled intravenous analgesia (PCIA) with sufentanil plus preoperative PVB (Group A, = 15) or postoperative PVB (Group B, = 15), or combination of preoperative and postoperative PVB (Group C, = 14). The primary outcome was sufentanil consumption and PCIA press times in the first 24 hours postoperatively. Also, data of postoperative use of PCIA and visual analogue scale (VAS) were collected. In the first 24 hours postoperatively, median sufentanil consumption in Group C was 0 (0-34.75) g, which was much less than that in Group A (45.00 (33.00-47.00) g, =0.005) and Group B (36 (20.00-50.00) g, =0.023). Patients in Group C pressed less times of PCIA (0 (0-0) times) than patients in Group A (2 (1-6) times, < 0.001) and Group B (2 (1-3) times, =0.009). Kaplan-Meier analysis showed patients with combination of preoperative and postoperative PVB had a higher PCIA-free rate than patients with either technique alone (=0.003). The VAS among the three groups was comparable postoperatively. The combination of both preoperative and postoperative PVB provides better analgesic efficacy during the early postoperative period and may be an alternative option for pain control after VATS. This trial is registered with ChiCTR1800017102.
尽管创伤较小，但接受电视辅助胸腔镜手术（VATS）的患者仍会遭受相当大的术后疼痛。椎旁阻滞（PVB）已被证明可在接受 VATS 的患者中提供有效的镇痛；然而，术前 PVB 和术后 PVB 之间在缓解疼痛方面没有差异。本研究旨在探讨同一接受 VATS 的患者行术前和术后 PVB 联合应用的镇痛效果。在这项前瞻性、双盲、随机对照试验中，纳入了 44 例接受 VATS 的患者，他们接受舒芬太尼加患者自控静脉镇痛（PCIA），并接受术前 PVB（A 组，n=15）或术后 PVB（B 组，n=15）或术前和术后 PVB 联合应用（C 组，n=14）。主要结局是术后 24 小时内舒芬太尼的消耗量和 PCIA 按压次数。还收集了术后使用 PCIA 和视觉模拟量表（VAS）的数据。在术后 24 小时内，C 组的舒芬太尼中位数消耗量为 0（0-34.75）g，明显少于 A 组（45.00（33.00-47.00）g，=0.005）和 B 组（36（20.00-50.00）g，=0.023）。C 组患者按压 PCIA 的次数较少（0（0-0）次），明显少于 A 组（2（1-6）次，<0.001）和 B 组（2（1-3）次，=0.009）。Kaplan-Meier 分析显示，行术前和术后 PVB 联合应用的患者 PCIA 无使用率高于单独使用任何一种技术的患者（=0.003）。三组术后 VAS 无差异。术前和术后 PVB 的联合应用在术后早期提供了更好的镇痛效果，可能是 VATS 后控制疼痛的另一种选择。本试验在中国临床试验注册中心注册，注册号为 ChiCTR1800017102。
