Yang Junling, Hao Zaijun, Li Wei, Duan Caiping, Fan Xiujuan, Xin Jing, Ren Chunguang
Department of Anesthesiology, Ordos Central Hospital, Ordos, People's Republic of China.
Department of Anesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, People's Republic of China.
J Pain Res. 2020 Feb 11;13:355-366. doi: 10.2147/JPR.S244787. eCollection 2020.
Although video-assisted thoracoscopic surgery (VATS) is increasingly used, the optimal analgesia strategy is still unknown. We explore the efficacy and safety of preemptive ultrasound-guided paravertebral block (PVB) combined with parecoxib during VATS.
Seventy-four patients were divided into two groups. PVBs were performed before anesthesia induction under real-time ultrasound guidance. Visual analog scale (VAS) score with coughing at 48 h after surgery, postoperative sufentanil consumption and level of sedation (LOS) at 1, 4, 8, 12, 24, and 48 h postoperatively, intraoperative hemodynamics, satisfaction scores of patients and surgeons, remedial measures, time to chest tube removed and mobilization, adverse effects and hospital stay length were recorded. We also recorded inflammatory markers, respiratory function and the prevalence of chronic pain after surgery.
VAS scores at rest and with coughing during the first 24 h after surgery were significantly lower in the P group (<0.05). Consumption of sevoflurane, remifentanil, and dexmedetomidine was all significantly reduced in the P group (<0.05). The consumption of sufentanil within 48 h after surgery, time to first dose and total dose of rescue ketorolac was significantly lower in the P group (<0.05). The FEV1/FVC ratio was significantly higher in the P group at 1 and 3 d after surgery (<0.05). Times to chest tube removal and mobilization were significantly shorter in the P group (<0.05). Compared with the C group, the level of both ACTH and cortisol was significantly reduced in the P group at 1 and 3 d after surgery (<0.05).
PVB combined with parecoxib was associated with better pain relief, decreased sufentanil and ketorolac consumption, less hemodynamic instability, and a lower surgery-related stress response. However, the incidences of chronic pain 3 and 6 months after surgery and the risk of complication except urinary retention were not significantly different between groups.
尽管电视辅助胸腔镜手术（VATS）的应用越来越广泛，但其最佳镇痛策略仍不明确。我们探讨了术前超声引导下椎旁阻滞（PVB）联合帕瑞昔布在VATS中的有效性和安全性。
74例患者分为两组。在实时超声引导下于麻醉诱导前进行PVB。记录术后48小时咳嗽时的视觉模拟评分（VAS）、术后舒芬太尼用量、术后1、4、8、12、24和48小时的镇静水平（LOS）、术中血流动力学、患者和外科医生的满意度评分、补救措施、胸管拔除时间和活动时间、不良反应及住院时间。我们还记录了炎症标志物、呼吸功能及术后慢性疼痛的发生率。
术后24小时内，P组静息和咳嗽时的VAS评分显著更低（<0.05）。P组七氟烷、瑞芬太尼和右美托咪定的用量均显著减少（<0.05）。P组术后48小时内舒芬太尼用量、首次使用剂量及酮咯酸总剂量显著更低（<0.05）。术后1天和3天，P组的FEV1/FVC比值显著更高（<0.05）。P组胸管拔除时间和活动时间显著更短（<0.05）。与C组相比，P组术后1天和3天的促肾上腺皮质激素（ACTH）和皮质醇水平均显著降低（<0.05）。
PVB联合帕瑞昔布可带来更好的疼痛缓解，减少舒芬太尼和酮咯酸用量，减少血流动力学不稳定，并降低手术相关应激反应。然而，术后3个月和6个月慢性疼痛的发生率以及除尿潴留外的并发症风险在两组间无显著差异。
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