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电视辅助肺楔形切除术后前锯肌平面阻滞的效果:一项单中心、前瞻性随机对照试验

Effects of a Serratus Anterior Plane Block After Video-Assisted Lung Wedge Resection: A Single-Center, Prospective, and Randomized Controlled Trial.

作者信息

Lee Seokjin, Sung Tae-Yun, Cho Choon-Kyu, Lee Gyuwon, Kwon Woojin

机构信息

Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon 35365, Republic of Korea.

Myunggok Medical Research Institute, Konyang University Hospital, Konyang University College of Medicine, Daejeon 35365, Republic of Korea.

出版信息

Medicina (Kaunas). 2024 Dec 26;61(1):11. doi: 10.3390/medicina61010011.

Abstract

: Video-assisted thoracoscopic surgery (VATS) is associated with less postoperative pain than traditional open thoracotomy. However, trocar and chest tube placement may damage the intercostal nerves, causing significant discomfort. An ultrasound-guided serratus anterior plane block (SAPB) is a promising mode of pain management; this reduces the need for opioids and the associated side-effects. This study evaluated whether SAPB, compared to intravenous analgesia alone, reduces opioid consumption after thoracoscopic lung wedge resection. : In total, 22 patients undergoing VATS lung wedge resections were randomized into two groups (SAPB and control): both received intravenous patient-controlled analgesia (PCA), and one group received additional SAPB. The primary outcome was the cumulative intravenous fentanyl consumption at 8 h postoperatively. The visual analog scale (VAS) pain scores and the incidence of postoperative complications were assessed over 48 h post surgery. : Fentanyl consumption by 8 h post surgery was significantly lower in the SAPB group than in the control group (183 ± 107 μg vs. 347 ± 202 μg, = 0.035). Although the VAS scores decreased with time in both groups, the differences were not statistically significant. The SAPB group required fewer opioids by 48 h. No significant between-group differences were observed in postoperative complications, including nausea and vomiting. : SAPB effectively reduced opioid consumption after VATS lung wedge resection. SABP may serve as a valuable component of multimodal pain management.

摘要

电视辅助胸腔镜手术(VATS)与传统开胸手术相比,术后疼痛较轻。然而,套管针和胸管置入可能会损伤肋间神经,导致明显不适。超声引导下前锯肌平面阻滞(SAPB)是一种很有前景的疼痛管理方式;这减少了阿片类药物的使用及其相关副作用。本研究评估了与单纯静脉镇痛相比,SAPB在胸腔镜肺楔形切除术后是否能减少阿片类药物的消耗。

总共22例行VATS肺楔形切除术的患者被随机分为两组(SAPB组和对照组):两组均接受静脉自控镇痛(PCA),其中一组还接受额外的SAPB。主要结局是术后8小时静脉注射芬太尼的累计消耗量。术后48小时评估视觉模拟量表(VAS)疼痛评分和术后并发症发生率。

术后8小时,SAPB组的芬太尼消耗量明显低于对照组(183±107μg对347±202μg,P = 0.035)。虽然两组的VAS评分均随时间下降,但差异无统计学意义。到48小时时,SAPB组所需的阿片类药物较少。在包括恶心和呕吐在内的术后并发症方面,未观察到组间有显著差异。

SAPB能有效减少VATS肺楔形切除术后的阿片类药物消耗。SABP可作为多模式疼痛管理的一个有价值的组成部分。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9db6/11766687/765a377adc41/medicina-61-00011-g001.jpg

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