Ranganathan Priya, Tadvi Asharab, Jiwnani Sabita, Karimundackal George, Pramesh C S
Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
Indian J Anaesth. 2020 Apr;64(4):280-285. doi: 10.4103/ija.IJA_714_19. Epub 2020 Mar 28.
Post-thoracotomy pain can be severe and disabling. The aim of this study was to examine the efficacy of intercostal nerve block when used as adjunct to thoracic epidural analgesia in patients undergoing posterolateral thoracotomy.
This was a parallel-group randomised patient and assessor-blinded study carried out at a tertiary-referral cancer center. We included 60 adult patients undergoing elective lung resection under general anaesthesia with thoracic epidural analgesia. In addition, the intervention arm received single-shot intercostal blocks with 10 ml of 0.25% bupivacaine at the level of and two levels above and below the thoracotomy. We assessed post-operative pain scores at 2 to 4 hours and 18 to 24 hours after surgery, peri-operative fentanyl requirement, percentage of patients who needed fentanyl PCA and maximum volume achieved on bedside spirometry 18 to 24 hours after surgery. Groups were compared using the unpaired -test for continuous data and the chi square test for categorical data at a 5% level of significance.
2 to 4 hours post-operatively, mean pain scores at rest were 3.0 in both groups (difference 0.04, 95% CI -1.1 to + 1.1) and on coughing were 4.6 (ICB group) and 4.9 (C group) (difference 0.32, 95% CI -1.0 to + 1.6). There were no differences between the groups for any of the other outcomes.
Addition of intercostal block to epidural analgesia does not confer any benefit in terms of post-operative pain, fentanyl requirements or volume achieved on spirometry.
开胸术后疼痛可能很严重且使人丧失活动能力。本研究的目的是探讨肋间神经阻滞作为辅助手段用于后外侧开胸手术患者的胸段硬膜外镇痛时的疗效。
这是一项在三级转诊癌症中心进行的平行组随机、患者和评估者双盲研究。我们纳入了60例在全身麻醉下行择期肺切除并采用胸段硬膜外镇痛的成年患者。此外，干预组在开胸切口平面及其上下各两个平面接受单次10 ml 0.25%布比卡因肋间阻滞。我们评估了术后2至4小时和18至24小时的疼痛评分、围手术期芬太尼需求量、需要芬太尼患者自控镇痛的患者百分比以及术后18至24小时床旁肺活量测定的最大肺活量。连续数据采用非配对t检验，分类数据采用卡方检验，以5%的显著性水平对组间进行比较。
术后2至4小时，两组静息时的平均疼痛评分均为3.0（差异0.04，95%可信区间-1.1至+1.1），咳嗽时分别为4.6（肋间阻滞组）和4.9（对照组）（差异0.32，95%可信区间-1.0至+1.6）。其他任何结局指标在两组之间均无差异。
硬膜外镇痛联合肋间阻滞在术后疼痛、芬太尼需求量或肺活量测定方面并无任何益处。
