From the Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark (JHH, CA, PT).
Eur J Anaesthesiol. 2024 Jan 1;41(1):61-69. doi: 10.1097/EJA.0000000000001921. Epub 2023 Nov 15.
The use of thoracic epidural analgesia for postoperative pain management in video-assisted thoracic surgery (VATS) is controversial. Still, the evidence on omitting it in favour of systemic opioids is inconclusive, and studies are small and non-blinded.
We aimed to compare pain after VATS using epidural analgesia or enteral opioids for postoperative pain management.
DESIGN/SETTING/PATIENTS/INTERVENTION: A randomised, double-blind, controlled trial at a Danish tertiary hospital. Adult patients scheduled for VATS were assigned to multimodal non-opioid baseline analgesia supplemented with either thoracic epidural analgesia (TE Group) or oral morphine (OM Group) for postoperative pain management. We recorded pain five times a day, both at rest and during activity, using the Numeric Rating Scale (NRS) and categorised it into "acceptable pain" or "unacceptable pain". Unacceptable pain was defined as NRS (at rest) ≥3 or NRS (with activity) ≥5 when supplementary analgesics were given.
The primary outcomes were the proportions of patients experiencing "unacceptable pain" during the postoperative period and the use of intravenous "rescue" opioids.
Of the 161 included patients, 146 received the allocated treatment and their data were analysed. At rest, 34% of patients in the TE Group and 64% of patients in the OM Group experienced unacceptable pain during the study period, a significant between-group difference of 30% ( P < 0.0005). During activity these percentages were 32% of patients in the TE Group and 59% in the OM group, a difference of 27% ( P < 0.005). The median intravenous rescue morphine consumption during the study period was 4.5 [interquartile range (IQR), 0-10.0] mg in the TE Group and 7.5 [0-19.0] mg in the OM Group ( P < 0.005).
Epidural analgesia provided better pain relief after VATS than oral morphine. The between-group difference in rescue intravenous morphine consumption was statistically significant but clinically irrelevant.
ClinicalTrials.gov (NCT02359175).
在电视辅助胸腔镜手术（VATS）中，使用胸段硬膜外镇痛来进行术后疼痛管理存在争议。然而，关于将其省略以支持全身阿片类药物的证据尚无定论，且研究规模较小且非盲法。
我们旨在比较 VATS 术后使用硬膜外镇痛或肠内阿片类药物进行疼痛管理的效果。
设计/设置/患者/干预：丹麦一家三级医院的一项随机、双盲、对照试验。计划接受 VATS 的成年患者被分配接受多模式非阿片类药物基础镇痛，辅以胸段硬膜外镇痛（TE 组）或口服吗啡（OM 组）进行术后疼痛管理。我们使用数字评分量表（NRS）每天五次记录疼痛，包括静息时和活动时的疼痛，并将其分为“可接受的疼痛”或“不可接受的疼痛”。当给予补充性镇痛药时，不可接受的疼痛定义为 NRS（静息时）≥3 或 NRS（活动时）≥5。
主要结局是术后期间经历“不可接受的疼痛”的患者比例和静脉“解救”阿片类药物的使用。
在纳入的 161 例患者中，146 例接受了分配的治疗，对其数据进行了分析。在静息时，TE 组中有 34%的患者和 OM 组中有 64%的患者在研究期间经历了不可接受的疼痛，两组之间存在 30%的显著差异（P<0.0005）。在活动时，TE 组中有 32%的患者和 OM 组中有 59%的患者经历了不可接受的疼痛，差异为 27%（P<0.005）。TE 组研究期间静脉内解救吗啡的中位数消耗量为 4.5[四分位间距（IQR），0-10.0]mg，OM 组为 7.5[0-19.0]mg（P<0.005）。
硬膜外镇痛在 VATS 后提供了比口服吗啡更好的疼痛缓解效果。两组之间静脉内解救吗啡消耗量的差异具有统计学意义，但临床意义不大。
ClinicalTrials.gov（NCT02359175）。
