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胸腔镜术后胸痛管理中的剥离按摩及文献复习。

Stripping Massage and Literature Review in Post-Thoracoscopic Chest Pain Management.

机构信息

National Taiwan University Hospital Yunlin Branch, YunLin County, Taiwan.

Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.

出版信息

Thorac Cardiovasc Surg. 2024 Sep;72(6):465-475. doi: 10.1055/a-2137-9035. Epub 2023 Jul 25.

Abstract

The aim of this randomized study was to investigate whether stripping massage (SM) of myofascial trigger points in the lower rhomboid muscle could alleviate chest pain in patients following thoracoscopic surgery. In addition, a literature review was conducted to assess the effectiveness of various pain management techniques. Sixty adult patients who reported a visual analog scale (VAS) score of 4 or higher were randomly assigned to receive conventional analgesics alone (conventional group) or combined with SM twice daily for 2 weeks (SM group). VAS scores and the use of additional analgesics were evaluated on postoperative days 1, 3, 7, 14, and 30. Using the PubMed and Cochrane Library databases, a review of current pain management techniques was carried out up to January 31, 2022. A subgroup analysis was also performed to examine the treatment effect during different surgical periods and techniques. Results showed that the SM group had significantly lower VAS scores on postoperative days 3, 7, 14, and 30 ( < 0.001), as well as a shorter hospitalization duration and reduced need for additional analgesics ( < 0.001). The literature review included a total of 20 studies (2,342 cases of chest pain relief after thoracoscopic surgery), which indicated that serratus anterior plane (SAP) blocks were commonly used as a perioperative approach to reduce pain and opioid consumption. SM and SAP can both serve as adjuvant treatments for chest pain in patients following thoracoscopic surgery, with SM being a safe and noninvasive pain control option after hospital discharge.

摘要

本随机研究旨在探讨下菱形肌肌筋膜触发点弹拨按摩(SM)是否可以减轻胸腔镜手术后患者的胸痛。此外,还进行了文献复习,以评估各种疼痛管理技术的有效性。60 名术后视觉模拟评分(VAS)为 4 或更高的成年患者被随机分配接受常规镇痛药物治疗(常规组)或联合每日两次 SM 治疗 2 周(SM 组)。在术后第 1、3、7、14 和 30 天评估 VAS 评分和额外镇痛药的使用情况。使用 PubMed 和 Cochrane Library 数据库,对截至 2022 年 1 月 31 日的当前疼痛管理技术进行了综述。还进行了亚组分析,以检查不同手术期间和技术的治疗效果。结果表明,SM 组在术后第 3、7、14 和 30 天的 VAS 评分明显较低(<0.001),住院时间更短,对额外镇痛药的需求减少(<0.001)。文献综述共包括 20 项研究(2342 例胸腔镜手术后胸痛缓解),表明前锯肌平面(SAP)阻滞常用于减少疼痛和阿片类药物的使用。SM 和 SAP 都可以作为胸腔镜手术后患者胸痛的辅助治疗方法,SM 是一种安全、非侵入性的出院后疼痛控制选择。

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