Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
The Pain Department, Zao Zhuang Municipal Hospital, Zaozhuang, Shandong Province, China.
Pain Physician. 2021 Sep;24(6):E753-E759.
Patients undergoing thoracic surgery frequently suffer from chronic pain after thoracotomy. Chronic pain can lead to a significant decline in a patient's quality of life. However, the effect of single-shot thoracic paravertebral block (TPVB) combined with intravenous analgesia on chronic pain incidence is unclear.
The objective was to evaluate the impact of single-shot TPVB combined with intravenous analgesia versus continuous thoracic epidural analgesia (TEA) on chronic pain incidence after thoracotomy.
A randomized controlled study.
Hospital department in China.
Ninety-six patients undergoing thoracotomy were randomly assigned to 2 groups: single-shot TPVB combined with intravenous analgesia (Group P) and continuous TEA (Group E). The pain intensity was assessed using the Verbal Rating Scale (VRS). The outcome measures were chronic pain incidence and the acute and chronic pain intensity.
The chronic pain incidence at rest in Group P was significantly higher than that in Group E at 3 months and 12 months postoperation (55.2% versus 28.6%, P = 0.019; 34.5% versus 14.3%, P = 0.027). The patients in Group E showed less pain intensity at rest compared with those in Group P at 3 months postoperation (0.0 versus 1.0, P = 0.034). At 6 hours and 24 hours postoperation, the acute pain intensity at coughing and at rest in Group E was lower than that in group P (VRS at coughing: 6 hours: 0.0 versus 2.0, P = 0.001; 24 hours: 3.0 versus 5.0, P = 0.010. VRS at rest: 6 hours: 0.0 versus 2.0, P = 0.000; 24 hours: 1.0versus. 2.0, P = 0.001).
An important limitation of this study is that it is not a double-blind study.
In patients undergoing thoracotomy, continuous TEA significantly reduced the chronic pain incidence at rest at 3 months and 12 months after operation and provided better acute pain relief up to 24 hours after operation compared with single-shot TPVB combined with intravenous analgesia.
接受开胸手术的患者常在开胸手术后出现慢性疼痛。慢性疼痛会导致患者的生活质量显著下降。然而，单次胸椎旁神经阻滞（TPVB）联合静脉镇痛对慢性疼痛发生率的影响尚不清楚。
评估单次 TPVB 联合静脉镇痛与连续胸椎硬膜外镇痛（TEA）对开胸手术后慢性疼痛发生率的影响。
随机对照研究。
中国医院科室。
96 例行开胸手术的患者随机分为两组：单次 TPVB 联合静脉镇痛（P 组）和连续 TEA（E 组）。采用视觉模拟评分法（VRS）评估疼痛强度。观察指标为慢性疼痛发生率以及急性和慢性疼痛强度。
术后 3 个月和 12 个月时，P 组静息时慢性疼痛发生率显著高于 E 组（55.2%比 28.6%，P=0.019；34.5%比 14.3%，P=0.027）。E 组患者术后 3 个月静息时疼痛强度小于 P 组（0.0 比 1.0，P=0.034）。术后 6 小时和 24 小时时，E 组咳嗽和静息时的急性疼痛强度均低于 P 组（咳嗽时 VRS：6 小时：0.0 比 2.0，P=0.001；24 小时：3.0 比 5.0，P=0.010。静息时 VRS：6 小时：0.0 比 2.0，P=0.000；24 小时：1.0 比 2.0，P=0.001）。
本研究的一个重要局限性是它不是一项双盲研究。
在接受开胸手术的患者中，与单次 TPVB 联合静脉镇痛相比，连续 TEA 可显著降低术后 3 个月和 12 个月时静息时的慢性疼痛发生率，并在术后 24 小时内提供更好的急性疼痛缓解。
