Trouillard Marion, Dupuis William, Siaudeau Hélène, Denou Florian, Longeau Emmanuelle, Léger Maxime, Ammi Myriam, Sargentini Cyril, Lasocki Sigismond, Rineau Emmanuel
Department of Anesthesiology and Intensive Care, University Hospital of Angers, 49100 Angers, France.
Department of Cardiovascular and Thoracic Surgery, University Hospital of Angers, 49100 Angers, France.
J Clin Med. 2022 Mar 2;11(5):1376. doi: 10.3390/jcm11051376.
Various regional anesthesia (RA) techniques were shown to reduce pain after lung surgery, but controversies remain regarding the best technique to use to improve recovery. In this observational prospective study, the aim was to assess the efficacy of an RA strategy depending on the surgical approach. Patients who underwent lung surgery were included if an RA was planned following our unit procedure (erector spinae plane block (ESP) for video-assisted thoracic surgery (VATS) and thoracic epidural analgesia (TEA) or intrathecal analgesia (IA) for thoracotomy). Patients were compared according to the RA used. In total, 116 patients were included, 70 (60%), 32 (28%), 14 (12%) in the ESP, TEA and IA groups, respectively. Between Day 1 and Day 3, median NRS values were ≤4 at rest, and <50% patients experienced moderate-to-severe pain in each group. There were no significant differences in opioid consumption and in pain at rest or during chest physiotherapy on Days 1 and 2 between groups. However, patients who received an IA had lower NRS than other groups on Day 0 and 3 and a shorter length of hospital stay in comparison with those who received a TEA. Thus, in our institution, a strategy combining ESP for VATS and TEA, or IA for thoracotomy, allowed for effective analgesia after a lung resection. Interestingly, IA appeared to be more effective than TEA in reducing the length of hospital stay and pain on Day 0 and 3.
多种区域麻醉（RA）技术已被证明可减轻肺手术后的疼痛，但对于采用哪种最佳技术来促进恢复仍存在争议。在这项前瞻性观察研究中，目的是根据手术方式评估一种RA策略的疗效。如果按照我们科室的程序计划进行RA（电视辅助胸腔镜手术（VATS）采用竖脊肌平面阻滞（ESP），开胸手术采用胸段硬膜外镇痛（TEA）或鞘内镇痛（IA）），则纳入接受肺手术的患者。根据所使用的RA对患者进行比较。总共纳入了116例患者，ESP组、TEA组和IA组分别有70例（60%）、32例（28%）、14例（12%）。在第1天至第3天期间，每组静息时的数字疼痛评分（NRS）中位数≤4，且<50%的患者经历中重度疼痛。各组之间在第1天和第2天的阿片类药物消耗量、静息时或胸部物理治疗期间的疼痛方面无显著差异。然而，接受IA的患者在第0天和第3天的NRS低于其他组，与接受TEA的患者相比住院时间更短。因此，在我们机构，一种将VATS的ESP与TEA或开胸手术的IA相结合的策略，可在肺切除术后实现有效的镇痛。有趣的是，IA在缩短住院时间以及减轻第0天和第3天的疼痛方面似乎比TEA更有效。
