O'Connor Lizabeth A, Dua Anahita, Orhurhu Vwaire, Hoepp Lawrence M, Quinn Curtis C
Department of Thoracic Surgery, Elliot Health System, Manchester, New Hampshire.
Department of Vascular Surgery, Massachusetts General Hospital, Boston, Massachusetts.
J Surg Res. 2022 Jun;274:232-241. doi: 10.1016/j.jss.2022.01.009. Epub 2022 Feb 18.
The optimal approach to pain management after thoracic surgery remains poorly defined. The purpose of this study was to examine the association between intercostal nerve cryoanalgesia and postoperative opioid requirements after thoracic surgery.
We conducted a single-center retrospective review of all patients who underwent unilateral thoracic surgery for pulmonary pathology from June 2017 to August 2019. Patients receiving intercostal nerve cryoanalgesia were compared with standard analgesia. The primary outcome was total oral morphine equivalent consumption during hospitalization, at discharge, and 90 d postoperatively. Secondary outcomes included pain scores and pulmonary function measured on postoperative days 1 and 3, at discharge, and postoperative complications. Planned subgroup analysis by opioid exposure and surgical approach was performed.
The Wilcoxon rank-sum test demonstrated significantly less inpatient opioid use for cryoanalgesia patients (45 versus 305 mg, P < 0.001), regardless of opioid history (naïve: 22.5 versus 209.8 mg, P < 0.001; tolerant: 159.5 versus 1043 mg, P < 0.001) and minimally invasive approach (opioid naïve: 26.2 versus 209.8 mg, P < 0.001; tolerant: 158.5 versus 1059 mg, P < 0.001). Opioid-naïve patients required fewer discharge opioids (50 versus 168 mg; P < 0.05). Cryoanalgesia lowered daily pain scores (P < 0.001) and showed a trend toward lower 90-d opioid prescriptions and higher pulmonary function scores. There was no difference in postoperative complications (P = 0.31).
Our results suggest an association between intercostal nerve cryoanalgesia and reduced inpatient opioid requirements and pain in opioid-naïve and tolerant patients. Pulmonary function, 90-d opioid prescriptions, and adverse events were no different between groups. It may serve as a useful adjunct for opioid-sparing pain management in thoracic surgery.
胸外科手术后疼痛管理的最佳方法仍未明确界定。本研究的目的是探讨肋间神经冷冻镇痛与胸外科手术后阿片类药物需求量之间的关联。
我们对2017年6月至2019年8月期间因肺部疾病接受单侧胸外科手术的所有患者进行了单中心回顾性研究。将接受肋间神经冷冻镇痛的患者与接受标准镇痛的患者进行比较。主要结局指标为住院期间、出院时及术后90天口服吗啡当量的总消耗量。次要结局指标包括术后第1天和第3天、出院时的疼痛评分和肺功能，以及术后并发症。按阿片类药物暴露情况和手术方式进行了计划中的亚组分析。
Wilcoxon秩和检验显示，无论阿片类药物使用史（初治患者：22.5毫克对209.8毫克，P<0.001；耐受患者：159.5毫克对1043毫克，P<0.001）和微创方式（初治阿片类药物患者：26.2毫克对209.8毫克，P<0.001；耐受患者：158.5毫克对1059毫克，P<0.001）如何，接受冷冻镇痛的患者住院期间阿片类药物使用量均显著减少（45毫克对305毫克，P<0.001）。初治阿片类药物患者出院时所需阿片类药物较少（50毫克对168毫克；P<0.05）。冷冻镇痛降低了每日疼痛评分（P<0.001），并显示出90天阿片类药物处方量较低和肺功能评分较高的趋势。术后并发症方面无差异（P=0.31）。
我们的结果表明肋间神经冷冻镇痛与初治阿片类药物患者及耐受患者住院期间阿片类药物需求量减少和疼痛减轻之间存在关联。两组之间的肺功能、90天阿片类药物处方量及不良事件无差异。它可能是胸外科手术中减少阿片类药物使用的疼痛管理的有用辅助手段
