Liu Yiming, Wang Chenyu, Ye Zhixiang, Jiang Ling, Miao Changhong, Liang Chao
Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Anesthesiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China.
Heliyon. 2024 Jul 31;10(15):e35436. doi: 10.1016/j.heliyon.2024.e35436. eCollection 2024 Aug 15.
Chronic postoperative pain (CPSP) is common after thoracic surgery, even after the less invasive video-assisted thoracoscopic surgery (VATS). This study investigated the effect of thoracic epidural anesthesia (TEA) on the development of CPSP.
We retrospectively analyzed the data of patients who underwent VATS at our center between 2020 and 2022. The enrolled patients were divided into the epidural block (EPI) and patient-controlled intravenous analgesia (PCIA) groups. A telephone questionnaire was used to collect information regarding CPSP, which was defined as a numerical rating scale (VAS) score ≥1 at 3 or 6 months postoperatively. Additionally, statistical analyses were performed to identify the risk factors for CPSP in the two groups.
Overall, 894 patients completed the follow-up interviews at 3 and 6 months, with 325 and 569 patients in the PCIA and EPI groups, respectively. The incidence rates of CPSP in the PCIA group at 3 and 6 months were 16.9 % (95 % confidence interval [CI]: 9.3-32.7 %) and 13.5 % (95 % CI: 8.7-33.4 %), and 10.3 % (95 % CI: 8.1-30.5 %) and 3.6 % (95 % CI: 3.5-21.5 %) in EPI group, respectively. The incidence of CPSP at 3 months (P = 0.0048) and 6 months (P < 0.005) was statistically significant in both groups. Age and lymph node dissection were significantly associated with CPSP.
Compared to PCIA, TEA was associated with a lower incidence of CPSP after VATS, and should be considered an important part of the analgesia regimen for patients with VATS.
慢性术后疼痛（CPSP）在胸外科手术后很常见，即使是在创伤较小的电视辅助胸腔镜手术（VATS）后。本研究调查了胸段硬膜外麻醉（TEA）对CPSP发生的影响。
我们回顾性分析了2020年至2022年在本中心接受VATS手术的患者数据。纳入的患者分为硬膜外阻滞（EPI）组和患者自控静脉镇痛（PCIA）组。通过电话问卷收集有关CPSP的信息，CPSP定义为术后3个月或6个月时数字评分量表（VAS）评分≥1分。此外，进行统计分析以确定两组中CPSP的危险因素。
总体而言，894例患者在3个月和6个月时完成了随访访谈，PCIA组和EPI组分别有325例和569例患者。PCIA组在3个月和6个月时CPSP的发生率分别为16.9%（95%置信区间[CI]：9.3 - 32.7%）和13.5%（95%CI：8.7 - 33.4%），EPI组分别为10.3%（95%CI：8.1 - 30.5%）和3.6%（95%CI：3.5 - 21.5%）。两组在3个月（P = 0.0048）和6个月（P < 0.005）时CPSP的发生率具有统计学意义。年龄和淋巴结清扫与CPSP显著相关。
与PCIA相比，TEA与VATS术后较低的CPSP发生率相关，应被视为VATS患者镇痛方案的重要组成部分。
