Department of Anesthesiology, Ningbo Medical Center Lihuili Hospital, Ningbo, 315040, China.
Department of Thoracic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo, 315040, China.
Esophagus. 2021 Jul;18(3):513-521. doi: 10.1007/s10388-020-00807-9. Epub 2021 Jan 6.
We observed the feasibility and effectiveness of multi-injection thoracic paravertebral block (TPB) via the intrathoracic approach under thoracoscopic direct vision for analgesia after thoracoscopic-laparoscopic esophagectomy (TLE).
Sixty patients undergoing TLE were randomly divided into a control group and an observation group. All patients underwent TPB via the intrathoracic approach at the three levels of T2, 5, and 8 with a scalp needle before closing the chest. The patients in the observation group received 10 ml 0.375% ropivacaine at each level, and the patients in the control group received 10 ml of 0.9% saline at each level. A patient-controlled intravenous analgesic (PCIA) pump with sufentanil was attached to all patients after surgery. The sufentanil consumption, number of PCIA presses and use of rescue analgesia in the first 24 h after surgery were recorded. The visual analogue scale (VAS) scores (rest and coughing) were recorded at 2 h, 6 h, 12 h, 24 h, and 48 h after surgery. The duration of postoperative hospital stay, active cough rate, first ambulation, and the incidence of adverse reactions after surgery was recorded.
The sufentanil consumption in the observation group was significantly lower than that in the control group (34.7 ± 1.9 µg vs. 52.1 ± 2.1 µg; P < 0.001). The VAS score at each postoperative time point, number of PCIA presses, use of rescue analgesia, and the incidence of adverse reactions in the observation group were significantly lower than those in the control group. The postoperative active cough rate of patients in the observation group was significantly higher than those in the control group, and the times of the first ambulation after surgery and postoperative hospital stay in the observation group were significantly shorter than those in the control group (all P < 0.05).
Multi-injection TPB via the intrathoracic approach under thoracoscopic direct vision is easy to perform and can effectively alleviate postoperative pain after TLE with fewer adverse reactions and contributing to improved postoperative recovery.
我们观察了经胸腔镜直视下经胸前路多部位胸椎旁阻滞（TPB）用于胸腔镜腹腔镜食管切除术（TLE）后镇痛的可行性和效果。
60 例行 TLE 的患者随机分为对照组和观察组。所有患者均在关胸前采用头皮针于 T2、5、8 三个水平进行经胸腔内 TPB。观察组患者在每个水平注射 10ml0.375%罗哌卡因，对照组患者在每个水平注射 10ml0.9%生理盐水。所有患者术后均连接舒芬太尼患者自控静脉镇痛（PCIA）泵。记录术后 24 小时内舒芬太尼的消耗量、PCIA 按压次数和补救性镇痛的使用情况。记录术后 2 小时、6 小时、12 小时、24 小时和 48 小时的视觉模拟评分（静息和咳嗽时）。记录术后住院时间、主动咳嗽率、首次下床活动时间和术后不良反应发生率。
观察组舒芬太尼用量明显低于对照组（34.7 ± 1.9µg vs. 52.1 ± 2.1µg；P < 0.001）。观察组各术后时间点的 VAS 评分、PCIA 按压次数、补救性镇痛使用率及不良反应发生率均明显低于对照组。观察组术后主动咳嗽率明显高于对照组，首次下床活动时间和术后住院时间明显短于对照组（均 P < 0.05）。
经胸腔镜直视下经胸前路多部位胸椎旁阻滞操作简单，能有效缓解 TLE 术后疼痛，不良反应少，有助于术后恢复。
