Hu Junqiang, Zhou Weichao, Zheng Xi, Zhang Anyu, Huang Qiang, Zhang Chunmei, Yao Yonghua, Lu Dianyu, Wei Wei
Department of Anaesthesiology, Guangzhou Institute of Cancer Research, Affiliated Cancer Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China.
Department of Anaesthesiology, First Affiliated Hospital of Guangzhou Medical University of Chinese Medicine, Guangzhou, Guangdong, China.
Anaesthesia. 2025 Jun 23. doi: 10.1111/anae.16651.
Video-assisted thoracoscopic lung resection causes significant postoperative pain. We hypothesised that continuous erector spinae plane block would provide non-inferior analgesia compared with a conventional opioid-based regimen for this procedure.
Patients were allocated randomly to continuous erector spinae plane block (continuous infusion of 0.25% ropivacaine via perineural catheters (5 ml.h) combined with programmed intermittent bolus (10 ml every 6 h for the initial 24 h)) or conventional opioid-based regimen (continuous infusion of opioid (2 μg.kg sufentanil and 16 mg ondansetron diluted to 100 ml with 0.9% normal saline) at 2 ml.h for 48 h). The primary outcome was overall analgesic efficacy with cough, quantified by the cumulative area under curve for the pain numeric rating scale scores, from post-anaesthesia care unit discharge to 48 h postoperatively.
The cumulative area under curve for the pain numeric rating scale score in patients allocated to the continuous erector spinae plane block group was non-inferior to those allocated to the conventional group (mean difference - 0.99, 95%CI -11.97-9.98, p = 0.011). Patients allocated to the continuous erector spinae plane block group showed superior quality of recovery-15 scores at 24 h (median difference 11, 95%CI 6-16, p < 0.001) and 48 h postoperatively (median difference 10, 95%CI 7-15, p < 0.001), alongside reduced postoperative pulmonary complications (relative risk 0.45, 95%CI 0.21-0.96, p = 0.031). Safety outcomes favoured continuous erector spinae plane block, with lower incidences of postoperative nausea (relative risk 0.17, 95%CI 0.04-0.73, p = 0.005); retching (relative risk 0.11, 95%CI 0.02-0.89, p = 0.023); and dizziness (relative risk 0.22, 95%CI 0.07-0.72, p = 0.005).
Following video-assisted thoracoscopic lung resection, continuous erector spinae plane block provides non-inferior postoperative analgesia compared with conventional opioid-based regimen whilst enhancing recovery quality significantly and reducing complications.
After a certain type of lung surgery done with a camera (called video‐assisted thoracoscopic surgery), patients often have a lot of pain. We wanted to see if using a special type of pain relief, called a ‘continuous erector spinae plane nerve block,’ worked just as well as regular strong oral pain medicine. We split the patients into two groups. One group got the special block, which slowly sent pain medicine (a numbing drug called ropivacaine) through a small tube into their back, with extra doses every few hours for one day. The other group got regular strong pain medicine (sufentanil, an opioid) through a drip for two days. We measured how much pain they felt when they coughed and how well the pain medicine worked over the first two days. The new pain relief method (the block) worked just as well as the regular pain medicine for helping with pain. But the patients who got the block felt better overall: they recovered better; had fewer problems after surgery; and felt less sick. They also had less nausea; less vomiting; and less dizziness. The special pain block helped patients just as much with pain as regular opioids did, but also helped them feel better, heal faster, and have fewer side effects. It may be a better choice for people having this type of lung surgery.
电视辅助胸腔镜肺切除术会导致显著的术后疼痛。我们假设,对于该手术,持续竖脊肌平面阻滞与传统的基于阿片类药物的方案相比,能提供非劣效的镇痛效果。
患者被随机分配至持续竖脊肌平面阻滞组(通过神经周围导管持续输注0.25%罗哌卡因(5 ml/h),并结合程序化间歇性推注(最初24小时每6小时10 ml))或传统的基于阿片类药物的方案组(持续输注阿片类药物(2 μg/kg舒芬太尼和16 mg昂丹司琼用0.9%生理盐水稀释至100 ml),以2 ml/h的速度持续48小时)。主要结局是咳嗽时的总体镇痛效果,通过从麻醉后监护病房出院至术后48小时疼痛数字评定量表评分的曲线下面积累计值来量化。
分配至持续竖脊肌平面阻滞组患者的疼痛数字评定量表评分曲线下面积累计值不劣于分配至传统组的患者(平均差值 -0.99, 95%CI -11.97 - 9.98, p = 0.011)。分配至持续竖脊肌平面阻滞组的患者在术后24小时(中位数差值11, 95%CI 6 - 16, p < 0.001)和48小时(中位数差值10, 95%CI 7 - 15, p < 0.001)的恢复质量-15评分更高,同时术后肺部并发症减少(相对风险0.45, 95%CI 0.21 - 0.96, p = 0.031)。安全性结局方面,持续竖脊肌平面阻滞更具优势,术后恶心(相对风险0.17, 95%CI 0.04 - 0.73, p = 0.005)、干呕(相对风险0.11, 95%CI 0.02 - 0.89, p = 0.023)和头晕(相对风险0.22, 95%CI 0.07 - 0.72, p = 0.005)的发生率更低。
电视辅助胸腔镜肺切除术后,持续竖脊肌平面阻滞与传统的基于阿片类药物的方案相比,能提供非劣效的术后镇痛效果,同时显著提高恢复质量并减少并发症。
在一种使用摄像头进行的肺部手术(称为电视辅助胸腔镜手术)后,患者通常会有很多疼痛。我们想看看一种特殊的止痛方法,称为“持续竖脊肌平面神经阻滞”,是否与常规的强效口服止痛药效果一样好。我们将患者分成两组。一组接受特殊阻滞,通过一根小管将止痛药(一种名为罗哌卡因的麻醉药)缓慢输入他们的背部,第一天每隔几个小时额外给药一次。另一组通过静脉滴注接受常规的强效止痛药(舒芬太尼,一种阿片类药物),持续两天。我们测量了他们咳嗽时的疼痛程度以及止痛药在前两天的效果。新的止痛方法(阻滞)在帮助止痛方面与常规止痛药效果一样好。但接受阻滞的患者总体感觉更好:他们恢复得更好;术后问题更少;感觉更舒服。他们的恶心、呕吐和头晕也更少。这种特殊的止痛阻滞在止痛方面对患者的帮助与常规阿片类药物一样大,但也帮助他们感觉更好、恢复更快且副作用更少。对于进行这种肺部手术的人来说,它可能是一个更好的选择。