Xu Mei, Feng Yuerou, Song Xiong, Fu Shuwen, Lu XiaoFan, Lai Jielan, Lu Yali, Wang Xudong, Lai Renchun
State Key Laboratory of Oncology in Southern China, Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Collaborative Innovation for Cancer Medicine, 651 Dongfeng Dong Lu, Yuexiu District, Guangzhou, Guangdong, China.
Guangdong Esophageal Cancer Institute, Guangzhou, China.
Pain Ther. 2023 Apr;12(2):475-489. doi: 10.1007/s40122-023-00474-5. Epub 2023 Jan 17.
Thoracic paravertebral block (TPVB) and subcostal transverse abdominis plane block (TAP) have been considered to provide an effective analgesic effect for laparoscopic and thoracoscopic surgery, respectively. The purpose of this randomized, controlled, and prospective study was to evaluate the analgesic effect of TPVB combined with TAP in patients undergoing total minimally invasive Mckeown esophagectomy.
Between February 2020 and December 2021, a total of 168 esophageal cancer patients undergoing McKeown esophagectomy at the Cancer Center of Sun Yat-Sen University, China, were randomly assigned to receive patient-controlled epidural analgesia alone (group PCEA, n = 56), patient-controlled intravenous analgesia alone (group PCIA, n = 56), and TPVB combined with TAP and patient-controlled intravenous analgesia (group PVB, n = 56). The primary outcome was a visual analogue scale (VAS) pain score on movement 48 h postoperatively. Secondary endpoints were pain scores at other points, intervention-related side effects, surgical complications, and length of intensive care unit and hospital stay. For the VAS pain score, the Kruskal-Wallis method was conducted for comparison of 3 treatment groups and further pairwise comparison with Bonferroni correction.
On movement, the VAS in the PVB group was higher than that in the PCEA group at 48 h, 72 h, 96 h, and 120 h postoperatively (p < 0.05) except in the postoperative anesthesia care unit (PACU) and 24 h postoperatively. The VAS in the PCIA group was higher than the PCEA and PVB groups in the first 4 days after surgery. The pulmonary complication rate in the PCIA group was significantly higher than the rate in the PCEA [95% Confidence Interval 0.214 (0.354, 0.067), p = 0.024].
Combined TPVB and TAP was more effective than intravenous opioid analgesia alone, while PCEA was more effective than TPVB combined with TAP and intravenous opioid analgesia for patients after McKeown esophagectomy.
Chinese Clinical Trial Registry; ChiCTR2000029588.
胸椎旁神经阻滞（TPVB）和肋下腹横肌平面阻滞（TAP）分别被认为可为腹腔镜手术和胸腔镜手术提供有效的镇痛效果。本随机、对照、前瞻性研究的目的是评估TPVB联合TAP对接受完全微创McKeown食管癌切除术患者的镇痛效果。
2020年2月至2021年12月，在中国中山大学肿瘤防治中心，共有168例接受McKeown食管癌切除术的食管癌患者被随机分配，分别接受单纯患者自控硬膜外镇痛（PCEA组，n = 56）、单纯患者自控静脉镇痛（PCIA组，n = 56）以及TPVB联合TAP和患者自控静脉镇痛（PVB组，n = 56）。主要结局指标为术后48小时活动时的视觉模拟量表（VAS）疼痛评分。次要终点为其他时间点的疼痛评分、干预相关的副作用、手术并发症以及重症监护病房住院时间和住院总时长。对于VAS疼痛评分，采用Kruskal-Wallis法对3个治疗组进行比较，并采用Bonferroni校正进行进一步的两两比较。
在活动时，除术后麻醉恢复室（PACU）和术后24小时外，PVB组术后48小时、72小时、96小时和120小时的VAS评分均高于PCEA组（p < 0.05）。PCIA组术后前4天的VAS评分高于PCEA组和PVB组。PCIA组的肺部并发症发生率显著高于PCEA组[95%置信区间0.214（0.354，0.067），p = 0.024]。
对于接受McKeown食管癌切除术的患者，TPVB联合TAP比单纯静脉使用阿片类药物镇痛更有效，而PCEA比TPVB联合TAP及静脉使用阿片类药物镇痛更有效。
中国临床试验注册中心；ChiCTR2000029588。
