Cheng Xin-Qi, Zhang Mao-Yun, Fang Qi, Shi De-Wen, Huang Xiao-Ci, Liu Xue-Sheng, Gu Er-Wei, Xu Guang-Hong
From the Department of Anaesthesiology, First Affiliated Hospital, Anhui Medical University and Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, Anhui, China.
Eur J Anaesthesiol. 2021 Sep 9. doi: 10.1097/EJA.0000000000001394.
Peripheral local anaesthetic blockade has an important role in multimodal postoperative analgesia after video-assisted thoracic surgery. Intercostal nerve block has an opioid-sparing effect after thoracoscopic surgery, but there is little information about an intra-operative opioid-sparing effect.
This prospective randomised trial was designed to evaluate the feasibility of a modified intercostal nerve block and its potential opioid-sparing effect during single-port thoracoscopic lobectomy.
This was a randomised controlled study.
The First Affiliated Hospital of Anhui Medical University, Hefei, China, from January 2020 to April 2020.
Fifty patients scheduled for single-port thoracoscopic lobectomy were enrolled.
Patients were randomised to receive the intercostal nerve block using 10 ml 0.35% ropivacaine (group MINB) or conventional general anaesthesia (group CGA). Following a bolus of 0.5 to 1.0 μg kg-1 remifentanil, it was then infused at 0.2 to 0.5 μg kg-1 min-1 during surgery to keep mean arterial pressure or heart rate values around 20% below baseline values.
The primary outcome was intra-operative remifentanil consumption.
Median [IQR] remifentanil consumption was reduced in the MINB group [0 μg (0 to 0 μg)] compared with the CGA group [1650.0 μg (870.0 to 1892.5 μg)]. The median difference was 1650.0 μg (95%CI 1200.0 to 1770.0 μg; P = 0.00). The total number of analgesic demands during the first 24 and 48 h in the MINB group was significantly less than in the CGA group (difference = 1; 95% CI 1 to 3; P = 0.00 and difference = 4; 95% CI 3 to 5; P = 0.00; respectively). The difference in time to first demand for analgesia was significant [difference = 728 min (95% CI 344 to 1381 min), P = 0.00] and also in the number of patients requiring additional tramadol (P = 0.03).
We have shown intra-operative opioid-sparing with a modified intercostal nerve block during single-port thoracoscopic lobectomy, with opioid-sparing extending 48 h after surgery. However, the opioid-sparing effect was not associated with a reduction in opioid side effects.
http://www.chictr.org.cn, ChiCTR2000029337.
外周局部麻醉阻滞在电视辅助胸腔镜手术后的多模式术后镇痛中具有重要作用。肋间神经阻滞在胸腔镜手术后具有节省阿片类药物的作用，但关于术中节省阿片类药物的作用的信息较少。
本前瞻性随机试验旨在评估改良肋间神经阻滞在单孔胸腔镜肺叶切除术中的可行性及其潜在的节省阿片类药物的作用。
这是一项随机对照研究。
2020年1月至2020年4月，中国合肥安徽医科大学第一附属医院。
纳入50例计划行单孔胸腔镜肺叶切除术的患者。
患者被随机分配接受使用10 ml 0.35%罗哌卡因的肋间神经阻滞（MINB组）或传统全身麻醉（CGA组）。在给予0.5至1.0 μg·kg-1瑞芬太尼负荷剂量后，术中以0.2至0.5 μg·kg-1·min-1的速度输注以维持平均动脉压或心率值比基线值低约20%。
主要观察指标是术中瑞芬太尼消耗量。
与CGA组[1650.0 μg（870.0至1892.5 μg）]相比，MINB组[0 μg（0至0 μg）]的瑞芬太尼消耗量中位数[四分位间距]降低。中位数差异为1650.0 μg（95%CI 1200.0至1770.0 μg；P = 0.00）。MINB组在术后最初24小时和48小时的镇痛需求总数明显少于CGA组（差异=1；95%CI 1至3；P = 0.00；差异=4；95%CI 3至5；P = 0.00）。首次镇痛需求时间的差异显著[差异=728分钟（95%CI 344至1381分钟），P = 0.00]，需要额外曲马多的患者数量差异也显著（P = 0.03）。
我们已证明在单孔胸腔镜肺叶切除术中改良肋间神经阻滞可在术中节省阿片类药物，且节省阿片类药物的作用在术后持续48小时。然而，节省阿片类药物的作用与阿片类药物副作用的减少无关。
