Omindo Willis Wasonga, Ping Wei, Qiu Ruixing, Zheng Shubin, Sun Qihang, Qian Yan, Zhang Ruijie, Zhang Ni, Zhou Biyun
Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
J Thorac Dis. 2024 Jul 30;16(7):4195-4207. doi: 10.21037/jtd-23-982. Epub 2024 Jul 18.
Despite widespread application of minimally invasive video-assisted thoracic surgery (VATS), postoperative pain following this procedure is still a constant clinical challenge. Serratus anterior plane (SAP) block is one of the regional analgesic techniques with promising outcomes. However, due to the limited duration of action, optimal analgesia is often not achieved with a single injection. We tested whether in patients who have been subjected to routine SAP block under preoperative anesthesia, the addition of a second SAP block 24 hours after surgery, improves quality of recovery, lowers postoperative opioid consumption, and reduces the prevalence of chronic pain.
The present study is a single institutional, prospective, randomized, triple-blinded, placebo-controlled study. Ninety patients undergoing VATS from January 2022 to April 2022 were randomized at 1:1 ratio to receive ultrasound-guided second SAP block with 15 mL 0.375% ropivacaine (SAP block group) or 15 mL normal saline (control group) 24 hours after both groups received routine SAP block with 15 mL 0.375% ropivacaine. The primary outcome was quality of patient recovery, measured using 40-item quality of recovery questionnaire (QoR-40) at postoperative day 2 (POD 2). Secondary outcomes included: postoperative pain scores at rest, postoperative opioid consumptions, number of times that patient controlled analgesia (PCA) pump button was pressed, perioperative complications and adverse effects, prevalence of chronic pain at 2 and 3 month postoperatively, and length of hospital stay (LOS).
A total of 83 patients completed the study: 43 patients in SAP block group and 40 patients in the control group. The global QoR-40 scores on POD 2 and POD 3 were significantly higher among SAP block group patients (180.07±11.34, 182.09±8.20) compared with the control group (172.18±6.15, 177.50±6.94) (P=0.01, P=0.008) respectively. Postoperative pain scores, opioid consumptions and incidence of postoperative nausea and vomiting were significantly lower among patients in SAP block group versus control group. There were no statistically significant differences in perioperative complications and LOS between the two groups. The prevalence of chronic pain at the 2 and 3 month postoperatively for patients in SAP block group and control group was 16.3%, 14%, and 32.5%, 27.5% respectively.
In patients undergoing VATS, application of ultrasound-guided second SAP block 24 hours after surgery improved postoperative quality of life, reduced opioid consumption and related side effects, and lowered the prevalence of chronic pain.
尽管微创电视辅助胸腔镜手术（VATS）已广泛应用，但该手术后的疼痛仍是一个持续存在的临床挑战。前锯肌平面（SAP）阻滞是一种具有良好前景的区域镇痛技术。然而，由于作用时间有限，单次注射往往无法实现最佳镇痛效果。我们测试了在术前麻醉下接受常规SAP阻滞的患者中，术后24小时追加第二次SAP阻滞是否能改善恢复质量、降低术后阿片类药物消耗量并降低慢性疼痛的发生率。
本研究是一项单中心、前瞻性、随机、三盲、安慰剂对照研究。2022年1月至2022年4月接受VATS的90例患者按1:1比例随机分组，两组均接受15 mL 0.375%罗哌卡因的常规SAP阻滞后，其中一组在术后24小时接受超声引导下15 mL 0.375%罗哌卡因的第二次SAP阻滞（SAP阻滞组），另一组接受15 mL生理盐水（对照组）。主要结局是患者恢复质量，在术后第2天（POD 2）使用40项恢复质量问卷（QoR - 40）进行测量。次要结局包括：静息时的术后疼痛评分、术后阿片类药物消耗量、患者自控镇痛（PCA）泵按钮按压次数、围手术期并发症和不良反应、术后2个月和3个月慢性疼痛的发生率以及住院时间（LOS）。
共有83例患者完成研究：SAP阻滞组43例，对照组40例。与对照组（分别为172.18±6.15、177.50±6.94）相比，SAP阻滞组患者在POD 2和POD 3的总体QoR - 40评分显著更高（分别为180.07±11.34、182.09±8.20）（P = 0.01，P = 0.008）。SAP阻滞组患者的术后疼痛评分、阿片类药物消耗量以及术后恶心呕吐的发生率均显著低于对照组。两组在围手术期并发症和LOS方面无统计学显著差异。SAP阻滞组和对照组患者术后2个月和3个月慢性疼痛的发生率分别为16.3%、14%和32.5%、27.5%。
在接受VATS的患者中，术后24小时应用超声引导下的第二次SAP阻滞可改善术后生活质量，减少阿片类药物消耗及相关副作用，并降低慢性疼痛的发生率。
