超声引导下肋间神经阻滞对胸腔镜手术后镇痛效果的影响：一项随机、双盲、临床试验。
The effect of ultrasound-guided intercostal nerve block on postoperative analgesia in thoracoscopic surgery: a randomized, double-blinded, clinical trial.
机构信息
Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, China.
出版信息
J Cardiothorac Surg. 2023 Apr 11;18(1):128. doi: 10.1186/s13019-023-02210-8.
BACKGROUND
Intercostal nerve block (ICNB) is a very effective analgesic method. We aimed to explore the effect of preemptive analgesia with ultrasound-guided intercostal nerve block on postoperative analgesia in thoracoscopic surgery.
METHODS
126 patients, aged 18-70 years, with American Society of Anesthesiologists (ASA) physical status I-II and scheduled for thoracoscopic pulmonary resection were enrolled in this study. 119 patients were left for final analysis. Patients were randomly allocated to group ICNB and group CONTROL. Patients in CONTROL group were administered sufentanil with patient-controlled analgesia device after operation In group ICNB, patients received ropivacaine ICNB prior to surgery and patient-controlled analgesia device after operation. The primary outcome is visual analog scale pain score (VAS) at rest at 0,4, 8,16,24,48,72 and 168 h postoperatively and they were compared. Surgical outcomes and rescue analgesia requirement were also recorded.
RESULTS
VAS scores were statistically significantly lower for ICNB group compared to control group at 0, 4, 8, 16, 24 and 48 h postoperatively. The duration of insertion of chest tube in ICBN group was shorter than that in control group, and the difference was statistically significant (4.69 ± 2.14 vs. 5.67 ± 2.86, P = 0.036). The postoperative hospital stay, incidence of nausea and vomiting and postoperative pulmonary infection rate in ICBN group were all lower than those in the control group, but there were no statistical differences. The frequency of rescue analgesia during 48 postoperative hours was different between the two groups (ICNB vs. Control; 9.83% vs. 31.03%, P = 0.004).
CONCLUSIONS
For patients undergoing thoracoscopic surgery, ultrasound-guided ICNB is simple, safe, and effective for providing acute postoperative pain management during the early postoperative stage.
TRIAL REGISTRATION
Chinese clinical trials: chictr.org.cn, ChiCTR1900021017. Registred on 25/01/2019.
背景
肋间神经阻滞（ICNB）是一种非常有效的镇痛方法。我们旨在探讨超声引导下肋间神经阻滞超前镇痛对胸腔镜手术术后镇痛的效果。
方法
本研究纳入了 126 名年龄在 18-70 岁之间、ASA 身体状况 I-II 级、计划行胸腔镜肺切除术的患者。最终有 119 名患者被纳入分析。患者被随机分配到 ICNB 组和 CONTROL 组。CONTROL 组患者术后使用舒芬太尼行患者自控镇痛；ICNB 组患者术前接受罗哌卡因 ICNB 阻滞，术后使用患者自控镇痛。主要观察指标为术后 0、4、8、16、24、48、72 和 168 小时静息时的视觉模拟评分（VAS），并进行比较。同时记录手术结果和补救性镇痛需求。
结果
与 CONTROL 组相比，ICNB 组患者术后 0、4、8、16、24 和 48 小时的 VAS 评分均显著降低。ICNB 组患者的胸腔引流管插入时间短于 CONTROL 组，差异具有统计学意义（4.69±2.14 比 5.67±2.86，P=0.036）。ICNB 组患者的术后住院时间、恶心呕吐发生率和术后肺部感染率均低于 CONTROL 组，但差异无统计学意义。两组患者术后 48 小时内补救性镇痛的频率不同（ICNB 组与 CONTROL 组；9.83%比 31.03%，P=0.004）。
结论
对于行胸腔镜手术的患者，超声引导下 ICNB 操作简单、安全、有效，可在术后早期提供急性术后疼痛管理。
临床试验注册
中国临床试验注册中心，ChiCTR1900021017。注册日期：2019 年 1 月 25 日。
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