Ajmal Syed, Johnstone Sarah, Tufail Muhammad, Panchal Rakesh K
Department of Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester.
J Bronchology Interv Pulmonol. 2024 Apr 1;31(2):183-187. doi: 10.1097/LBR.0000000000000937.
Intercostal nerve block (ICNB) has long been used in thoracic surgery. Local anesthetic thoracoscopy (LAT) is performed under conscious sedation with local anesthesia at the port insertion site. This alone, however, does not anesthetize the parietal pleura from where biopsies are taken and patients can experience pain.
To compare LAT with multilevel ICNB versus standard care to determine whether it reduces pain during and post-LAT, its effect on analgesia use, the hospital length of stay (LOS), and related complications.
Prospective analysis of patients undergoing LAT between January and June 2021. In the ICNB group, levobupivacaine/xylocaine is administered at the angle of the rib immediately before LAT (up to 5 rib spaces). Visual Analog Score for pain (0 to 100 mm) was measured at 1 and 2 hours post-LAT and daily including analgesia use.
Twenty patients (10 ICNB vs. 10 standard care group). The mean age is 68 years with 70% males. Visual Analog Score for pain in the ICNB group reduced by 55 mm at 1 and 2 hours post-LAT and 45 mm at day 1 ( P <0.05) (minimal clinically important difference >16 mm]. Median LOS was reduced by 50% in the ICNB group ( P <0.05). Paracetamol use reduced by 56% ( P <0.05).
ICNB not only significantly reduces postprocedure pain but also reduces LOS.
肋间神经阻滞（ICNB）长期以来一直用于胸外科手术。局部麻醉胸腔镜检查（LAT）是在端口插入部位局部麻醉下进行清醒镇静的情况下实施的。然而，仅此一项并不能麻醉获取活检组织的壁层胸膜，患者可能会感到疼痛。
比较LAT联合多级ICNB与标准护理，以确定其是否能减轻LAT期间及术后的疼痛、对镇痛药物使用的影响、住院时间（LOS）以及相关并发症。
对2021年1月至6月期间接受LAT的患者进行前瞻性分析。在ICNB组中，在LAT前立即于肋骨角处给予左旋布比卡因/利多卡因（最多5个肋间隙）。在LAT后1小时和2小时以及每日测量疼痛视觉模拟评分（0至100毫米），包括镇痛药物的使用情况。
20例患者（10例ICNB组 vs. 10例标准护理组）。平均年龄为68岁，男性占70%。ICNB组在LAT后1小时和2小时疼痛视觉模拟评分降低了55毫米，在第1天降低了45毫米（P<0.05）（最小临床重要差异>16毫米）。ICNB组的中位住院时间减少了50%（P<0.05）。对乙酰氨基酚的使用减少了56%（P<0.05）。
ICNB不仅能显著减轻术后疼痛，还能缩短住院时间。
