Division of Vascular Surgery, University of Rochester, Rochester, NY.
Department of Anesthesiology, University of Rochester, Rochester, NY.
Ann Vasc Surg. 2023 Jan;88:283-290. doi: 10.1016/j.avsg.2022.07.021. Epub 2022 Sep 2.
Rib resection in thoracic outlet decompression can result in significant postoperative pain requiring high levels of opioid medications. We evaluated the impact of a bupivacaine infusing pleural catheter on postoperative pain and opioid usage in patients undergoing rib resection for thoracic outlet syndrome. We hypothesized that delivery of local anesthetic via the pleural catheter would improve postoperative pain control compared to standard multimodal analgesia, and that the use of the catheter would decrease opioid use during the index hospitalization and prescriptions for opioid pain medications at discharge.
We conducted a single-center retrospective cohort study of 26 patients who underwent rib resection for thoracic outlet decompression. Primary outcome was opioid consumption during the index hospitalization, measured in morphine milligram equivalents (MME). Secondary outcomes were MME prescribed at discharge and pain scores during the index hospitalization before and after the pleural drain and pleural catheter were removed.
Patients in the bupivacaine infusion pleural catheter group (n = 11) had significantly lower MME usage during the index hospitalization (22.5 [1.9, 65.6] vs. 119.8 [76.5, 167.4]), and significantly lower MME prescribed at discharge (0 [0, 37.5] vs. 225 [183, 315]), compared to standard multimodal analgesia in controls (n = 15). Only 3 patients in the bupivacaine pleural catheter group were discharged with any opioid prescriptions (27%), compared to 14 patients in the control group (93%). There was no difference in postoperative pain scores between groups before or after removal of the pleural drain, which was placed in all cases (P = 0.31 and P = 0.76, respectively).
Intraoperative placement of a bupivacaine infusion pleural catheter significantly reduced opioid use during the index hospitalization and opioid prescribing at discharge. Anesthetic infusion pleural catheters should be the treatment modality of choice for postoperative pain management in patients undergoing thoracic outlet decompression.
在进行胸廓出口减压术时，肋骨切除会导致明显的术后疼痛，需要使用高剂量的阿片类药物。我们评估了在胸廓出口综合征患者中进行肋骨切除时，使用布比卡因胸腔内输注导管对术后疼痛和阿片类药物使用的影响。我们假设通过胸腔导管输送局部麻醉剂将改善术后疼痛控制，与标准多模式镇痛相比，并且导管的使用将减少索引住院期间的阿片类药物使用和出院时阿片类药物疼痛药物的处方。
我们进行了一项单中心回顾性队列研究，纳入了 26 例因胸廓出口减压而行肋骨切除术的患者。主要结局是在索引住院期间使用阿片类药物的情况，以吗啡毫克当量（MME）衡量。次要结局是在胸腔引流管和胸腔导管拔除前后的索引住院期间开具的 MME 处方和疼痛评分。
布比卡因输注胸腔导管组（n=11）在索引住院期间的 MME 使用量显著较低（22.5[1.9，65.6]与 119.8[76.5，167.4]），出院时开具的 MME 处方量也显著较低（0[0，37.5]与 225[183，315]），与对照组（n=15）的标准多模式镇痛相比。在布比卡因胸腔导管组中，只有 3 例患者出院时开有任何阿片类药物处方（27%），而对照组中有 14 例（93%）。两组在胸腔引流管拔除前后的术后疼痛评分均无差异，所有病例均放置了胸腔引流管（分别为 P=0.31 和 P=0.76）。
术中放置布比卡因输注胸腔导管可显著减少索引住院期间的阿片类药物使用和出院时的阿片类药物处方。在进行胸廓出口减压术的患者中，麻醉性胸腔内导管应成为术后疼痛管理的首选治疗方式。
