Ministry of Health Ankara Bilkent City Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey.
University of Health Sciences, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, Turkey.
BMC Anesthesiol. 2023 Sep 4;23(1):297. doi: 10.1186/s12871-023-02264-0.
To investigate the effects of body mass index (BMI) on intensity postoperative pain in patients who underwent thoracic paravertebral block (TPVB) for postoperative analgesia after video-assissted thoracoscopic surgery (VATS).
Patients aged 18-80 years, ASA I-III, and BMI 18-40 kg/m who underwent elective VATS were included in the study. The patients were divided into 3 groups according to their BMI levels. TPVB was performed under ultrasound-guidance at the fifth thoracic vertebrae, and 30 ml of 0.25% bupivacaine was injected. The patient-controlled analgesia (PCA) was performed by using morphine and multimodal analgesia was performed. As a rescue analgesic agent, 0.5 mg/kg tramadol was given to patients intravenously when a score of visual analog scale (VAS) at rest was ≥ 4. The primary outcome was determined as VAS scores at rest and cough. Secondary outcomes were determined as postoperative morphine consumption, additional analgesic requirement, and side effects.
The post-hoc test revealed that the VAS resting scores at the 4 hour (p: 0.007), 12 hour (p: 0.014), and 48 hour (p: 0.002) were statistically significantly lower in Group I compared to Group II. Additionally, VAS resting scores were also statistically significantly lower in Group I compared to Group III at all time points (p < 0.05). Similarly, the post-hoc test indicated that the VAS coughing scores at the 4 hour (p: 0.023), 12 hour (p: 0.011), and 48 hour (p: 0.019) were statistically significantly lower in Group I compared to Group II. Moreover, VAS coughing scores were statistically significantly lower in Group I compared to Group III at all time points (p < 0.001). Furthermore, there were statistically significant differences in terms of additional analgesic use between the groups (p: 0.001). Additionally, there was a statistically significant difference in terms of morphine consumption via PCA and morphine milligram equivalent consumption between the groups (p < 0.001).
Higher postoperative VAS scores with TPVB applied in obese patients and the consequent increase in additional analgesics and complications require more specific postoperative management in this patient group.
研究了体质量指数（BMI）对接受电视辅助胸腔镜手术（VATS）后行胸椎旁神经阻滞（TPVB）行术后镇痛的患者术后疼痛强度的影响。
选择择期行 VATS 的年龄 18-80 岁、ASA 分级 I-III 级和 BMI 为 18-40kg/m2 的患者。根据 BMI 水平将患者分为 3 组。在超声引导下行第 5 胸椎 TPVB，注入 30ml0.25%布比卡因。采用吗啡行患者自控镇痛（PCA），行多模式镇痛。当静息时视觉模拟评分（VAS）评分≥4 分，给予患者 0.5mg/kg 曲马多静脉内补救镇痛。主要结局为静息和咳嗽时 VAS 评分。次要结局为术后吗啡消耗量、额外镇痛需求和副作用。
事后检验显示，第 4 小时（p：0.007）、12 小时（p：0.014）和 48 小时（p：0.002）时，I 组的静息 VAS 评分明显低于 II 组。此外，I 组在所有时间点的静息 VAS 评分均明显低于 III 组（p<0.05）。同样，事后检验显示，第 4 小时（p：0.023）、12 小时（p：0.011）和 48 小时（p：0.019）时，I 组的咳嗽 VAS 评分明显低于 II 组。此外，I 组在所有时间点的咳嗽 VAS 评分均明显低于 III 组（p<0.001）。此外，各组之间的额外镇痛药物使用存在统计学差异（p：0.001）。此外，各组之间 PCA 吗啡消耗量和吗啡毫克当量消耗量存在统计学差异（p<0.001）。
在肥胖患者中，TPVB 术后 VAS 评分较高，需要更多的额外镇痛药物，并发症也相应增加，这需要对该患者群体进行更具体的术后管理。
