Lu Yugang, Zhou Qing, Fu Yu, Wen Zongmei, Lv Xin
Department of Anesthesiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
J Pain Res. 2023 Feb 3;16:373-381. doi: 10.2147/JPR.S398349. eCollection 2023.
Simultaneous bilateral pulmonary resection via uniportal video-assisted thoracoscopic surgery (UVATS) was safe and feasible for the treatment of bilateral multiple pulmonary nodules. But, it should be noted that considerable postoperative pain at the bilateral surgical site was a crucial issue. The safety and efficacy of bilateral thoracic paravertebral block (TPVB) have been reported for postoperative analgesia. But, whether bilateral sequential TPVB can be safely and effectively used in simultaneous bilateral UVATS remains unknown. Therefore, this study aimed to determine the analgesic efficacy and safety of bilateral sequential TPVB after simultaneous bilateral UVATS.
In this study, 80 participants scheduled for UVATS will be randomly allocated to the bilateral sequential TPVB group (G) and the control group (G). The patient of G will be performed bilateral TPVB at 2 time-points: before the start of the first side of pulmonary resection and before the start of the contralateral pulmonary resection. G will only receive standard analgesia protocol. The primary outcome is the numeric rating scale score during coughing at 24 h postoperatively. The secondary outcomes include the Prince Henry Pain Score scores, sufentanil consumption, postoperative nausea and vomiting, levels of inflammatory factors, and the Quality of Recovery-40 scores at different time points, as well as chronic pain at postoperative day (POD) 90.
This is the first prospective trial to determine the safety and effectiveness of ultrasound-guided bilateral sequential TPVB for postoperative analgesia following simultaneous bilateral UVATS. This study also intended to evaluate the effect of this intervention on postoperative quality of recovery and inflammation levels. The final results will provide clinical evidence related to bilateral sequential TPVB, and promote the application of that acting as a more appropriate analgesic method for simultaneous bilateral UVATS.
经单孔电视辅助胸腔镜手术（UVATS）同期双侧肺切除治疗双侧多发肺结节是安全可行的。但需要注意的是，双侧手术部位术后疼痛明显是一个关键问题。双侧胸椎旁神经阻滞（TPVB）用于术后镇痛的安全性和有效性已有报道。但是，双侧序贯TPVB能否安全有效地用于同期双侧UVATS尚不清楚。因此，本研究旨在确定同期双侧UVATS后双侧序贯TPVB的镇痛效果和安全性。
本研究中，80例计划行UVATS的参与者将被随机分配至双侧序贯TPVB组（G组）和对照组（G组）。G组患者将在2个时间点进行双侧TPVB：在第一侧肺切除开始前和对侧肺切除开始前。G组仅接受标准镇痛方案。主要结局是术后24小时咳嗽时的数字评分量表评分。次要结局包括不同时间点的Prince Henry疼痛评分、舒芬太尼用量、术后恶心呕吐、炎症因子水平、恢复质量-40评分，以及术后第90天的慢性疼痛。
这是第一项确定超声引导下双侧序贯TPVB用于同期双侧UVATS术后镇痛的安全性和有效性的前瞻性试验。本研究还旨在评估这种干预对术后恢复质量和炎症水平的影响。最终结果将提供与双侧序贯TPVB相关的临床证据，并促进其作为同期双侧UVATS更合适的镇痛方法的应用。
