Chen Yuanqing, Cai Yaoyao, Ye Yingchao, Xia Yun, Papadimos Thomas J, Liu Le, Xu Xuzhong, Wang Quanguang, Shi Kejian, Wu Yiquan
Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, People's Republic of China.
Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
J Pain Res. 2021 Mar 19;14:785-791. doi: 10.2147/JPR.S295913. eCollection 2021.
Intrapleural analgesia has been increasingly recommended for postoperative analgesia after thoracic surgery. However, the analgesic effect provided by a single intrapleural administration is time limited. This study reports the efficacy and safety of repeated intrapleural 0.75% ropivacaine administration after thoracoscopic surgery.
Twenty patients were randomly divided into two groups: a single administration group receiving a single intrapleural injection of 0.75% ropivacaine 15 mL (single administration group, SA group), and a repeated administration group with an intrapleural injection of 0.75% ropivacaine 15 mL every 4h for 4 doses (repeated administration group, RA group). The primary outcomes of this study were the peak plasma concentration of ropivacaine and 24h morphine consumption. The secondary outcomes were pain score, patient satisfaction, extubation time, hospital length of stay, and adverse reactions.
In SA group, the highest plasma concentration after intrapleural administration of 0.75% ropivacaine 15 mL was 1345±364 μg/L. The highest plasma concentration in RA group after the fourth administration was 1864±492 μg/L. The 24h morphine consumption in RA group was significantly less than that in SA group (9.0±5.66 vs 15.9±3.48 mg, =0.004). The NRS scores at rest and while coughing of patients in RA group were significantly lower than those in SA group at 5, 9, 13, 17 and 24h after operation. The patients in RA group had higher satisfaction than those in SA group. There was no significant difference in postoperative adverse events, drainage tube placement days and hospital length of stay between the two groups.
Repeated intrapleural administration with 0.75% ropivacaine, 15 mL every 4h for 4 doses after video-assisted thoracoscopic lobectomies, can provide a more durable and more effective analgesic effect than single intrapleural administration. Repeated intrapleural administration of ropivacaine is an effective postoperative method of analgesia resulting in higher patient satisfaction. Moreover, it was also able to keep the plasma concentration of ropivacaine within a possible safe range.
ChiCTR-IOR-17010560.
胸膜内镇痛越来越多地被推荐用于胸外科手术后的镇痛。然而，单次胸膜内给药提供的镇痛效果是有限的。本研究报告了胸腔镜手术后重复胸膜内注射0.75%罗哌卡因的有效性和安全性。
20例患者随机分为两组：单次给药组接受单次胸膜内注射15 mL 0.75%罗哌卡因（单次给药组，SA组），重复给药组每4小时胸膜内注射15 mL 0.75%罗哌卡因，共4次（重复给药组，RA组）。本研究的主要结局是罗哌卡因的血浆峰浓度和24小时吗啡消耗量。次要结局包括疼痛评分、患者满意度、拔管时间、住院时间和不良反应。
SA组胸膜内注射15 mL 0.75%罗哌卡因后的最高血浆浓度为1345±364 μg/L。RA组第4次给药后的最高血浆浓度为1864±492 μg/L。RA组的24小时吗啡消耗量显著低于SA组（9.0±5.66 vs 15.9±3.48 mg，P = 0.004）。术后5、9、13、17和24小时，RA组患者静息和咳嗽时的NRS评分显著低于SA组。RA组患者的满意度高于SA组。两组术后不良事件、引流管留置天数和住院时间差异无统计学意义。
胸腔镜肺叶切除术后每4小时重复胸膜内注射15 mL 0.75%罗哌卡因，共4次，比单次胸膜内给药能提供更持久、更有效的镇痛效果。重复胸膜内注射罗哌卡因是一种有效的术后镇痛方法，可提高患者满意度。此外，它还能将罗哌卡因的血浆浓度保持在可能的安全范围内。
ChiCTR-IOR-17010560。
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