Jiang Ling, Wang Chengyu, Tong Jie, Han Xiaodan, Miao Changhong, Liang Chao
Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Anesthesiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, People's Republic of China.
J Clin Anesth. 2025 Jan;100:111685. doi: 10.1016/j.jclinane.2024.111685. Epub 2024 Nov 27.
To test the hypothesis that thoracic epidural anesthesia and analgesia (TEA) reduces the incidence of chronic postoperative pain (CPSP) after video-assisted thoracoscopic surgery (VATS).
A single-center, single-blind, randomized controlled trial was conducted.
The study was conducted in the operating room, with follow-up assessments performed in the ward. Telephone was used to follow the long-term outcomes.
231 patients ≥18 years of age and scheduled for VATS.
Patients were randomized into two groups, including an epidural block (EPI) group (general anesthesia with patient-controlled epidural analgesia) and a general anesthesia with patient-controlled intravenous analgesia (PCIA) group.
The primary endpoint was the incidence of CPSP at 3 months postoperatively. CPSP data, including acute pain, neuropathic pain, depression, and side effects, were collected at 3 and 6 months postoperatively through telephone follow-up.
A total of 231 patients were analyzed, including 114 in the PCIA group and 117 in the EPI group. Sixty-six patients (56.4 %) in the PCIA group and 33 patients (28.9 %) in the EPI group experienced chronic pain at 3 months postoperatively. The odds ratio (OR) was 0.31 (95 % confidence interval [CI], 0.18 to 0.54; P < 0.0001). After adjusting for confounding factors, the adjusted OR was 0.28 (95 % CI, 0.16 to 0.50, P < 0.001). Six months postoperatively, 50 (42.7 %) and 17 (14.9 %) patients in the PCIA and EPI groups, respectively, were diagnosed with CPSP (P < 0.0001).
检验胸段硬膜外麻醉与镇痛（TEA）可降低电视辅助胸腔镜手术（VATS）后慢性术后疼痛（CPSP）发生率这一假设。
开展一项单中心、单盲、随机对照试验。
研究在手术室进行，在病房进行随访评估。通过电话追踪长期结果。
231例年龄≥18岁且计划行VATS的患者。
患者被随机分为两组，包括硬膜外阻滞（EPI）组（全身麻醉联合患者自控硬膜外镇痛）和全身麻醉联合患者自控静脉镇痛（PCIA）组。
主要终点是术后3个月时CPSP的发生率。术后3个月和6个月通过电话随访收集CPSP数据，包括急性疼痛、神经性疼痛、抑郁和副作用。
共分析231例患者，其中PCIA组114例，EPI组117例。PCIA组66例患者（56.4%）和EPI组33例患者（28.9%）在术后3个月出现慢性疼痛。优势比（OR）为0.31（95%置信区间[CI]，0.18至0.54；P<0.0001）。校正混杂因素后，校正后的OR为0.28（95%CI，0.16至0.50，P<0.001）。术后6个月，PCIA组和EPI组分别有50例（42.7%）和17例（14.9%）患者被诊断为CPSP（P<0.0001）。
