Kim Sujin, Song Seung Woo, Lee Haesung, Byun Chun Sung, Park Ji-Hyoung
Department of Anesthesiology and Pain Medicine, Wonju College of Medicine, Yonsei University, Wonju, 26426, Korea.
Department of Thoracic and Cardiovascular Surgery, Wonju College of Medicine, Yonsei University, Wonju, 26426, Korea.
BMC Anesthesiol. 2025 Jan 7;25(1):11. doi: 10.1186/s12871-025-02888-4.
Various analgesic techniques have been applied, the pain after video assisted thoracic surgery (VATS) is still challenging for anesthesiologists. Paracetamol provide analgesic efficacy in many surgeries. However, clinical evidence in the lung surgery with regional block remain limited. This monocentric double-blind randomized controlled trial investigates the efficacy of paracetamol after VATS with regional block.
A total of 90 patients were randomized to receive paracetamol (1 g) or normal saline. Erector Spinae Plane Block and Intercostal Nerve block were applied during the surgery. The Visual Analogue Scales (VAS) pain score was measured in the PACU as well as 6, 12, 24, and 48 h postoperatively. And the total dose of rescue analgesics administered to patients in morphine milligram equivalents (MME), satisfaction score, length of hospital stays, and incidence of nausea and vomiting were also recorded.
The VAS pain score at each time point, the primary endpoint, did not differ between the groups (3.09 ± 2.14 vs. 2.53 ± 1.67, p = 0.174 at PACU; 4.56 ± 2.80 vs. 4.06 ± 2.46, p = 0.368 at 6 h; 3.07 ± 1.98 vs. 3.44 ± 2.48, p = 0.427 at 12 h; 2.10 ± 2.00 vs. 2.49 ± 2.07, p = 0.368 at 24 h; and 1.93 ± 1.76 vs. 2.39 ± 1.97, p = 0.251 at 48 h postoperatively). Satisfaction scores (4.37 ± 0.76 vs. 4.14 ± 0.88, p = 0.201), nausea (35.6% vs. 37.8%, p = 0.827), hypotension (2.2% vs. 0.0%, p = 0.317), and bradycardia (6.7% vs. 2.2%, p = 0.309) were also reported at similar rates.
The analgesic efficacy of one gram of paracetamol with ESPB and ICNB after VATS was not proven. Thus, caution should be exercised when prescribing paracetamol for pain control during VATS.
this trial was registered on Clinical Research Information Service (CRIS), Republic of Korea (KCT0008710). Registration date: 17/08/2023.
尽管已经应用了多种镇痛技术，但电视辅助胸腔镜手术（VATS）后的疼痛对麻醉医生来说仍然具有挑战性。对乙酰氨基酚在许多手术中都具有镇痛效果。然而，在区域阻滞的肺部手术中的临床证据仍然有限。这项单中心双盲随机对照试验研究了区域阻滞下VATS后对乙酰氨基酚的疗效。
总共90名患者被随机分为接受对乙酰氨基酚（1克）或生理盐水组。手术期间应用竖脊肌平面阻滞和肋间神经阻滞。在麻醉后恢复室（PACU）以及术后6、12、24和48小时测量视觉模拟量表（VAS）疼痛评分。还记录了以吗啡毫克当量（MME）为单位给予患者的抢救性镇痛药的总剂量、满意度评分、住院时间以及恶心和呕吐的发生率。
各时间点的VAS疼痛评分（主要终点）在两组之间没有差异（PACU时为3.09±2.14 vs. 2.53±1.67，p = 0.174；6小时时为4.56±2.80 vs. 4.06±2.46，p = 0.368；12小时时为3.07±1.98 vs. 3.44±2.48，p = 0.427；24小时时为2.10±2.00 vs. 2.49±2.07，p = 0.368；术后48小时时为1.93±1.76 vs. 2.39±1.97，p = 0.251）。满意度评分（4.37±0.76 vs. 4.14±0.88，p = 0.201）、恶心（35.6% vs. 37.8%，p = 0.827）、低血压（2.2% vs. 0.0%，p = 0.317）和心动过缓（6.7% vs. 2.2%，p = 0.309）的发生率也相似。
VATS后1克对乙酰氨基酚联合竖脊肌平面阻滞和肋间神经阻滞的镇痛效果未得到证实。因此，在VATS期间开具对乙酰氨基酚用于疼痛控制时应谨慎。
本试验在大韩民国临床研究信息服务（CRIS）上注册（KCT0008710）。注册日期：2023年8月17日。
