Hu Lihong, Xu Xia, Tian Hui, He Jinxian
Department of Anesthesiology, Ningbo Medical Center Lihuili Hospital, Ningbo, China.
Department of Thoracic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo, China.
Pain Ther. 2021 Jun;10(1):433-442. doi: 10.1007/s40122-020-00231-y. Epub 2021 Jan 9.
Pain is still severe after single-port video-assisted thoracoscopic (SPVAT) lung wedge resection. We observed the effect of single-injection thoracic paravertebral block (TPB) via the intrathoracic approach for analgesia after SPVAT lung wedge resection.
Sixty patients undergoing SPVAT lung wedge resection were randomly divided into a control group and an observation group. All patients underwent TPB via the intrathoracic approach at the T4 level with a scalp needle before closing the chest. The patients in the observation group received 20 ml 0.375% ropivacaine at the T4 level, and the patients in the control group received 20 ml of 0.9% saline. A patient-controlled intravenous analgesic (PCIA) pump with sufentanil was attached to all patients after surgery. The sufentanil consumption and number of PCIA presses in the first 24 h after surgery were recorded. The visual analogue scale (VAS) scores (during rest and coughing) were recorded at 6 h, 12 h, 24 h, and 36 h after surgery. The incidence of adverse reactions after surgery were recorded.
The sufentanil consumption in the observation group was significantly lower than that in the control group (34.2 ± 1.9 µg vs. 52.3 ± 2.3 µg; P < 0.001). The VAS score at 6, 12, and 24 h after surgery, the incidence of adverse reactions after surgery in the observation group were significantly lower than those in the control group (all P < 0.05). The number of PCIA presses in the observation group was significantly lower than that in the control group [0 (0-0) times vs. 3 (2-4) times, P < 0.001].
Single-injection TPB via the intrathoracic approach under thoracoscopic direct vision is easy to perform and can effectively alleviate postoperative pain after SPVAT lung wedge resection, with fewer adverse reactions.
ChiCTR2000034726.
单孔电视辅助胸腔镜（SPVAT）肺楔形切除术后疼痛仍较为严重。我们观察了经胸腔内途径单次注射胸椎旁阻滞（TPB）用于SPVAT肺楔形切除术后镇痛的效果。
60例行SPVAT肺楔形切除术的患者被随机分为对照组和观察组。所有患者在关胸前行T4水平经胸腔内途径头皮针胸椎旁阻滞。观察组患者在T4水平注射20 ml 0.375%罗哌卡因，对照组患者注射20 ml 0.9%生理盐水。术后所有患者均连接舒芬太尼患者自控静脉镇痛（PCIA）泵。记录术后24小时内舒芬太尼用量及PCIA按压次数。记录术后6小时、12小时、24小时和36小时的视觉模拟评分（VAS）（静息和咳嗽时）。记录术后不良反应发生率。
观察组舒芬太尼用量显著低于对照组（34.2±1.9μg对52.3±2.3μg；P<0.001）。术后6小时、12小时和24小时的VAS评分、观察组术后不良反应发生率均显著低于对照组（均P<0.05）。观察组PCIA按压次数显著低于对照组[0（0 - 0）次对3（2 - 4）次，P<0.001]。
胸腔镜直视下经胸腔内途径单次注射TPB操作简便，能有效减轻SPVAT肺楔形切除术后疼痛，不良反应较少。
ChiCTR2000034726。
