亚甲蓝胸椎旁神经阻滞对电视辅助胸腔镜肺叶切除术后疼痛的疗效
Efficacy of Methylene Blue Thoracic Paravertebral Block in Postoperative Pain After VATS Lobectomy.
作者信息
Leonardi Beatrice, Natale Giovanni, Leone Francesco, Messina Gaetana, Fiorito Roberta, Coppolino Francesco, Pace Maria Caterina, Chiodini Paolo, Di Domenico Marina, Fiorelli Alfonso
机构信息
Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, Naples, Italy.
Anesthesiology Unit, University of Campania Luigi Vanvitelli, Naples, Italy.
出版信息
Ann Thorac Surg Short Rep. 2024 Jan 19;2(2):166-171. doi: 10.1016/j.atssr.2023.12.013. eCollection 2024 Jun.
BACKGROUND
Paravertebral block (PVB) is effective in controlling postoperative pain after video-assisted thoracoscopic surgery (VATS) lobectomy but is subject to a high rate of failure because of incorrect site of injection. We compared methylene blue PVB with thoracic epidural anesthesia (TEA) for postoperative pain after VATS lobectomy.
METHODS
We conducted a prospective randomized trial of patients undergoing VATS lobectomy; 120 patients were randomly assigned to the PVB or TEA group. The end points were postoperative pain at 1 hour, 12 hours, 24 hours, and 48 hours; time to perform TEA and PVB; opioid consumption; and postoperative outcomes.
RESULTS
PVB was associated with reduction of local anesthesia time ( < .0001). In 2 cases, methylene blue showed that the block was not well performed; thus, it was repeated. No significant differences were found in postoperative pain, opioid consumption, and postoperative outcomes.
CONCLUSIONS
PVB with methylene blue is as effective as TEA for controlling postoperative pain. Methylene blue use could help reduce PVB failure.
背景
椎旁阻滞（PVB）在电视辅助胸腔镜手术（VATS）肺叶切除术后控制疼痛方面有效，但由于注射部位不正确，失败率较高。我们比较了亚甲蓝PVB与胸段硬膜外麻醉（TEA）用于VATS肺叶切除术后的疼痛控制情况。
方法
我们对接受VATS肺叶切除术的患者进行了一项前瞻性随机试验；120例患者被随机分配至PVB组或TEA组。观察终点为术后1小时、12小时、24小时和48小时的疼痛情况；实施TEA和PVB的时间；阿片类药物的消耗量；以及术后结局。
结果
PVB与局部麻醉时间缩短相关（<0.0001）。有2例患者，亚甲蓝显示阻滞效果不佳，因此进行了重复阻滞。术后疼痛、阿片类药物消耗量和术后结局方面未发现显著差异。
结论
亚甲蓝PVB在控制术后疼痛方面与TEA同样有效。使用亚甲蓝有助于降低PVB的失败率。
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