Department of Anesthesiology, Peking University People's Hospital, Beijing, China.
Clin J Pain. 2021 Oct 1;37(10):759-765. doi: 10.1097/AJP.0000000000000969.
Acute pain intensity is a strong indicator for the occurrence of persistent postsurgical pain (PPP) after video-assisted thoracic surgery (VATS). The effect of preoperative serratus anterior muscle plane block (SAPB) on PPP was investigated.
In this retrospective cohort study, data of 148 patients who underwent VATS for lung nodules in 2019 were collected. Seventy-four patients received a single-shot of SAPB with 0.33% ropivacaine 30 mL after anesthesia induction and another 74 patients received intercostal blocks using 1% ropivacaine 10 mL at the fifth to seventh intercostal spaces after surgery. Postoperative analgesia was accomplished by continuous infusion of flurbiprofen (8 mg/h), and intravenous oxycodone rescue (1 mg) given on demand. Pain intensity was recorded at 24 and 48 hours after surgery and all patients were followed up 3 months after surgery investigating the occurrence of PPP.
Intraoperative sufentanil in the SAPB group was significantly decreased in comparison with Control group (0.34±0.09 vs. 0.43±0.14 ug/kg, P<0.001). The incidence of PPP was comparable between 2 groups (20.2% [15/74] vs. 14.8% [11/74], P=0.078). All patients who experienced PPP rated their PPP as mild, except 1 patient in Control group rated her pain as moderate. Multivariate logistic regression showed that pain score at 24 hours (odds ratio 1.646, 95% confidence interval [1.058, 2.560], P=0.027) and female (odds ratio 3.711, 95% confidence interval [1.274, 10.810], P=0.026) were independent risk factors for the development of PPP.
When SAPB was combined with continuous infusion of nonsteroidal anti-inflammatory drugs, no patient had moderate chronic pain. Pain score at 24 hours after surgery and female were risk factors for PPP after VATS.
急性疼痛强度是电视辅助胸腔镜手术后（VATS）持续性术后疼痛（PPP）发生的一个强有力的指标。本研究旨在探讨术前胸肌前间隙阻滞（SAPB）对 PPP 的影响。
本回顾性队列研究收集了 2019 年行 VATS 治疗肺结节的 148 例患者的数据。74 例患者在麻醉诱导后接受单次 SAPB 注射，0.33%罗哌卡因 30mL；另外 74 例患者在术后第 5 至 7 肋间隙接受 1%罗哌卡因 10mL 肋间阻滞。术后通过连续输注氟比洛芬（8mg/h）和按需给予静脉注射羟考酮（1mg）进行术后镇痛。术后 24 小时和 48 小时记录疼痛强度，所有患者术后 3 个月随访，观察 PPP 的发生情况。
SAPB 组术中舒芬太尼用量明显低于对照组（0.34±0.09 比 0.43±0.14μg/kg，P<0.001）。两组 PPP 的发生率无差异（20.2%[15/74]比 14.8%[11/74]，P=0.078）。所有发生 PPP 的患者均将其疼痛评为轻度，除 1 例对照组患者将其疼痛评为中度。多变量逻辑回归显示，术后 24 小时疼痛评分（优势比 1.646，95%置信区间[1.058，2.560]，P=0.027）和女性（优势比 3.711，95%置信区间[1.274，10.810]，P=0.026）是 PPP 发生的独立危险因素。
当 SAPB 与非甾体抗炎药持续输注联合使用时，没有患者出现中度慢性疼痛。术后 24 小时疼痛评分和女性是 VATS 后发生 PPP 的危险因素。
