CT 引导下经胸穿刺活检术患者中局部胸膜麻醉控制疼痛的效果和安全性。

The effectiveness and safety of local pleural anesthesia for pain control in patients undergoing CT-guided transthoracic needle biopsy.

机构信息

Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seocho-gu, Seoul, 06591, Republic of Korea.

出版信息

Eur Radiol. 2021 Nov;31(11):8282-8290. doi: 10.1007/s00330-021-07969-9. Epub 2021 Apr 22.

DOI:10.1007/s00330-021-07969-9

PMID:33890148

Abstract

OBJECTIVES

To evaluate the effectiveness and safety of pleural anesthesia for CT-guided transthoracic needle biopsy (TNB).

METHODS

This retrospective study was performed between March 2019 and August 2019 in a tertiary care hospital. Patients undergoing CT-guided TNB received either (a) pleural and skin anesthesia (pleural anesthesia group) or (b) skin anesthesia only (skin anesthesia group). Pain score was reported on a 0-5 numeric rating scale, and pain scores 3-5 were classified as significant pain. The relationship between pleural anesthesia and pain score, significant pain, and pneumothorax was assessed by using multivariable linear and logistic regression models.

RESULTS

A total of 111 patients (67 men, 66.0 ± 11.4 years) were included (pleural anesthesia group, 38; skin anesthesia group, 73). Pleural anesthesia group reported lower pain score (1.4 ± 1.0 vs. 2.3 ± 1.1, p < 0.001) and less frequent significant pain (18.4% [7/38] vs. 42.5% [31/73], p = 0.020) than skin anesthesia group. Pain score was negatively associated with pleural anesthesia (β = -0.93, p < 0.001) and positively associated with procedure time (β = 0.06, p < 0.001). Significant pain was negatively associated with pleural anesthesia (p = 0.004, adjusted odds ratio [OR] = 0.21 [95% confidence interval: 0.07, 0.61]) and positively associated with procedure time (p < 0.001, adjusted OR = 1.15 [95% confidence interval: 1.07, 1.24]). Pleural anesthesia was not associated with pneumothorax or chest tube placement (p = 0.806 and 0.291, respectively).

CONCLUSION

Pleural anesthesia reduces subjective pain without increasing the risk of pneumothorax.

KEY POINTS

• Local pleural anesthesia is a simple method that can be added to the conventional skin anesthesia for CT-guided transthoracic needle biopsy. • The addition of local pleural anesthesia can effectively reduce pain compared to the conventional skin anesthesia method. • This procedure is not associated with an increased risk of pneumothorax or chest tube placement.

摘要

目的

评估胸膜麻醉在 CT 引导下经胸穿刺活检（TNB）中的有效性和安全性。

方法

这是一项回顾性研究，于 2019 年 3 月至 2019 年 8 月在一家三级保健医院进行。接受 CT 引导 TNB 的患者接受以下两种方式之一的麻醉：（a）胸膜和皮肤麻醉（胸膜麻醉组）或（b）仅皮肤麻醉（皮肤麻醉组）。疼痛评分采用 0-5 数字评分量表报告，评分 3-5 分被归类为显著疼痛。采用多变量线性和逻辑回归模型评估胸膜麻醉与疼痛评分、显著疼痛和气胸之间的关系。

结果

共纳入 111 例患者（67 例男性，66.0±11.4 岁）（胸膜麻醉组 38 例，皮肤麻醉组 73 例）。与皮肤麻醉组相比，胸膜麻醉组的疼痛评分（1.4±1.0 对 2.3±1.1，p＜0.001）和显著疼痛发生率（18.4%[7/38]对 42.5%[31/73]，p=0.020）均较低。疼痛评分与胸膜麻醉呈负相关（β=-0.93，p＜0.001），与手术时间呈正相关（β=0.06，p＜0.001）。显著疼痛与胸膜麻醉呈负相关（p=0.004，调整后的优势比[OR]为 0.21[95%置信区间：0.07，0.61]），与手术时间呈正相关（p＜0.001，调整后的 OR 为 1.15[95%置信区间：1.07，1.24]）。胸膜麻醉与气胸或胸腔引流管放置无关（p=0.806 和 0.291）。