Kusano Yukari, Kawagoe Izumi, Yamaguchi Ai, Kishii Jun, Morita Yuki, Fukuda Masataka, Kochiyama Tsukasa, Hayashida Masakazu
Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan.
Ann Transl Med. 2023 Mar 15;11(5):206. doi: 10.21037/atm-22-4258. Epub 2023 Mar 9.
Recently, robot-assisted thoracic surgery has been increasingly performed for mediastinal disease. However, appropriate postoperative analgesic methods have not been evaluated.
We retrospectively studied patients who underwent robot-assisted thoracic surgery for mediastinal disease at a single university hospital between January 2019 and December 2021. Patients were performed either general anesthesia alone, general anesthesia combined with thoracic epidural anesthesia, or general anesthesia combined with ultrasound-guided thoracic block. Patients were divided into three groups [non-block (NB), thoracic epidural analgesia (TEA), and thoracic paraspinal block (TB)] according to postoperative analgesic methods, and they compared with terms of postoperative pain scores by using numerical rating scale (NRS) at 0, 3, 6, 12, 18, 24, and 48 h. Additionally, rescue supplemental analgesic within 24 h, side effects of anesthesia such as respiratory depression, hypotension, postoperative nausea and vomiting, pruritus and urinary retention, time to ambulation after surgery, and hospital stay after surgery were also compared among the three groups.
Data from 169 patients (Group NB: 25, Group TEA: 102, and Group TB: 42) were progressed to the analysis. Postoperative pain scale at 6 and 12 h was significantly lower in Group TEA than NB (1.2±1.6 . 2.4±1.8, P<0.01; and 1.2±1.5 . 2.2±1.7, P=0.018, respectively). There were no differences in pain scores between Groups TB and TEA at any point. The incidence of patients using rescue analgesics within 24 h was significantly different between groups [Group NB: 15/25 (60%), Group TEA: 30/102 (29.4%), Group TB: 25/42 (59.5%), P=0.01]. For postoperative side effects, only the number of patients complaining of postoperative nausea and vomiting for 24 h after surgery differed significantly between groups [Group NB: 7/25 (28%), Group TEA: 19/102 (18.6%), Group TB: 1/42 (2.4%), P=0.01].
TEA provided better analgesia after robot-assisted thoracic surgery for mediastinal disease than NB as indicated by lower pain scores and fewer rescue analgesic requirements. However, the frequency of postoperative nausea and vomiting was lowest in Group TB of all the groups. Thus, TBs might also provide adequate postoperative analgesia following robot-assisted thoracic surgery for mediastinal disease.
近年来，机器人辅助胸外科手术在纵隔疾病治疗中的应用日益增多。然而，尚未对合适的术后镇痛方法进行评估。
我们回顾性研究了2019年1月至2021年12月期间在一所大学医院接受机器人辅助胸外科纵隔疾病手术的患者。患者分别接受单纯全身麻醉、全身麻醉联合胸段硬膜外麻醉或全身麻醉联合超声引导下胸段阻滞。根据术后镇痛方法将患者分为三组[非阻滞组（NB）、胸段硬膜外镇痛组（TEA）和胸段椎旁阻滞组（TB）]，并在术后0、3、6、12、18、24和48小时使用数字评分量表（NRS）比较术后疼痛评分。此外，还比较了三组患者术后24小时内的补救性补充镇痛情况、麻醉副作用如呼吸抑制、低血压、术后恶心呕吐、瘙痒和尿潴留、术后下床活动时间以及术后住院时间。
169例患者的数据（NB组：25例，TEA组：102例，TB组：42例）纳入分析。TEA组术后6小时和12小时的疼痛评分显著低于NB组（分别为1.2±1.6对2.4±1.8，P<0.01；以及1.2±1.5对2.2±1.7，P=0.018）。TB组和TEA组在任何时间点的疼痛评分均无差异。三组患者术后24小时内使用补救性镇痛药的发生率有显著差异[NB组：15/25（60%），TEA组：30/102（29.4%），TB组：25/42（59.5%），P=0.01]。对于术后副作用，仅术后24小时内抱怨恶心呕吐的患者数量在三组间有显著差异[NB组：7/25（28%），TEA组：19/102（18.6%），TB组：1/42（2.4%），P=0.01]。
TEA组在机器人辅助胸外科纵隔疾病手术后的镇痛效果优于NB组，表现为疼痛评分更低且补救性镇痛药需求更少。然而，所有组中TB组术后恶心呕吐的发生率最低。因此，TB组在机器人辅助胸外科纵隔疾病手术后也可能提供充分的术后镇痛。
