La Via Luigi, Cavaleri Marco, Terminella Alberto, Sorbello Massimiliano, Cusumano Giacomo
Department of Anesthesia and Intensive Care, Azienda Ospedaliera Universitaria Policlinico "G. Rodolico-San Marco", 95123 Catania, Italy.
Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Policlinico "G. Rodolico-San Marco", 95123 Catania, Italy.
J Clin Med. 2024 May 27;13(11):3141. doi: 10.3390/jcm13113141.
Robotic thoracic surgery is a prominent minimally invasive approach for the treatment of various thoracic diseases. While this technique offers numerous benefits including reduced blood loss, shorter hospital stays, and less postoperative pain, effective pain management remains crucial to enhance recovery and minimize complications. This review focuses on the application of various loco-regional anesthesia techniques in robotic thoracic surgery, particularly emphasizing their role in pain management. Techniques such as local infiltration anesthesia (LIA), thoracic epidural anesthesia (TEA), paravertebral block (PVB), intercostal nerve block (INB), and erector spinae plane block (ESPB) are explored in detail regarding their methodologies, benefits, and potential limitations. The review also discusses the imperative of integrating these anesthesia methods with robotic surgery to optimize patient outcomes. The findings suggest that while each technique has unique advantages, the choice of anesthesia should be tailored to the patient's clinical status, the complexity of the surgery, and the specific requirements of robotic thoracic procedures. The review concludes that a multimodal analgesia strategy, potentially incorporating several of these techniques, may offer the most effective approach for managing perioperative pain in robotic thoracic surgery. Future directions include refining these techniques through technological advancements like ultrasound guidance and exploring the long-term impacts of loco-regional anesthesia on patient recovery and surgical outcomes in the context of robotic thoracic surgery.
机器人辅助胸外科手术是治疗各种胸科疾病的一种重要的微创方法。虽然这项技术具有诸多益处，包括减少失血、缩短住院时间和减轻术后疼痛，但有效的疼痛管理对于促进康复和减少并发症仍然至关重要。本综述重点关注各种局部区域麻醉技术在机器人辅助胸外科手术中的应用，尤其强调它们在疼痛管理中的作用。详细探讨了局部浸润麻醉（LIA）、胸段硬膜外麻醉（TEA）、椎旁阻滞（PVB）、肋间神经阻滞（INB）和竖脊肌平面阻滞（ESPB）等技术的方法、益处和潜在局限性。本综述还讨论了将这些麻醉方法与机器人手术相结合以优化患者预后的必要性。研究结果表明，虽然每种技术都有独特的优势，但麻醉方式的选择应根据患者的临床状况、手术的复杂性以及机器人辅助胸科手术的具体要求进行调整。本综述得出结论，一种可能结合多种这些技术的多模式镇痛策略，可能为管理机器人辅助胸外科手术围手术期疼痛提供最有效的方法。未来的方向包括通过超声引导等技术进步来改进这些技术，并在机器人辅助胸外科手术的背景下探索局部区域麻醉对患者康复和手术结果的长期影响。
