优化开胸术后疼痛管理：比较开胸手术患者的竖脊肌阻滞与椎旁阻滞：一项前瞻性随机研究。

Optimizing post-thoracotomy pain management: comparing erector spinae vs. paravertebral block in thoracotomy patients: a prospective randomized study.

作者信息

Baser Kerem, Adiyeke Ozal, Mendes Ergun, Gumus Ozcan Funda

机构信息

Health Ministery Sancaktepe Sehıt Prof Dr Ilhan Varank Research and Education, Department of Anesthesiology And Reanimation Clinic, Istanbul, Istanbul, Turkey.

Department Of Anesthesiology And Reanimation Clinic, Health Ministery Basaksehir Cam And Sakura City Hospital, Basaksehir, Istanbul, Turkey.

出版信息

BMC Anesthesiol. 2025 Jul 30;25(1):368. doi: 10.1186/s12871-025-03237-1.

DOI:10.1186/s12871-025-03237-1

PMID:40739476

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12308981/

Abstract

BACKGROUND

Postoperative pain can lead to serious complications in the short and medium term. It may also increase the risk of converting acute pain into chronic pain, leading to the development of postthoracotomy pain syndrome (PTPS). The aim of this study was to demonstrate the effectiveness of erector spinae plane block (ESPB) and paravertebral block (PVB) in managing acute postoperative pain and preventing the development of PTPS in patients undergoing thoracotomy and lobectomy.

METHODS

This prospective, randomized study included American Society of Anesthesiologists (ASA) class II-III patients aged 18–70 years who underwent elective unilateral lobectomy via a thoracotomy. The study was conducted at Başakşehir Çam and Sakura City Hospital, following approval from the hospital’s ethics committee on May 20, 2022 (protocol number: KAEK.2022.05.155). Patients were randomly assigned into ESPB ( = 30) and PVB ( = 30) groups using a computer-generated randomization sequence prior to surgery. Intravenous patient-controlled analgesia (PCA) was provided for 24 h postoperatively. Resting numerical rating scala (NRS) and Prince Henry Hospital Pain Scale (PHHPS) scores were evaluated at 0, 2, 6, 12, and 24 h after surgery. Pain levels were further assessed via telephone interviews using the NRS at 2 weeks and 2 months postoperatively.

RESULTS

The baseline NRS score was significantly lower in the PVB group (3.97 ± 0.61) compared to the ESPB group (4.37 ± 0.85) ( = 0.044). The mean number of PCA requests, mean opioid consumption and number of patients receiving rescue analgesics were significantly lower in the PVB group than in the ESPB group ( < 0.05). No significant differences were observed between the groups in hemodynamic parameters ( > 0.05). PTPS developed in 3 patients (1 in PVB, 2 in ESPB), with no significant intergroup difference ( = 0.561).

CONCLUSIONS

PVB and ESPB provided effective acute pain control after thoracotomy, with PVB showing superior outcomes in analgesic use and pain scores. Early management of postoperative pain may improve short-term recovery and potentially reduce PTPS incidence, which was 5% in our study—lower than reported in the literature.

TRIAL REGISTRATION

ClinicalTrials.gov (ID NCT06964698). The clinical trial was retrospectively registered on April 02, 2025.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s12871-025-03237-1.

摘要

背景

术后疼痛在短期和中期可导致严重并发症。它还可能增加急性疼痛转为慢性疼痛的风险，从而导致开胸术后疼痛综合征（PTPS）的发生。本研究的目的是证明竖脊肌平面阻滞（ESPB）和椎旁阻滞（PVB）在开胸手术和肺叶切除术患者中管理急性术后疼痛及预防PTPS发生方面的有效性。

方法

这项前瞻性、随机研究纳入了年龄在18至70岁、美国麻醉医师协会（ASA）分级为II-III级、接受择期单侧肺叶切除开胸手术的患者。该研究于2022年5月20日获得医院伦理委员会批准后（方案编号：KAEK.2022.05.155）在巴沙克谢希尔樱花市医院进行。术前使用计算机生成的随机序列将患者随机分为ESPB组（n = 30）和PVB组（n = 30）。术后24小时提供静脉自控镇痛（PCA）。在术后0、2、6、12和24小时评估静息数字评分量表（NRS）和亨利王子医院疼痛量表（PHHPS）评分。术后2周和2个月通过电话访谈使用NRS进一步评估疼痛程度。

结果

与ESPB组（4.37±0.85）相比，PVB组的基线NRS评分显著更低（3.97±0.61）（P = 0.044）。PVB组的PCA平均请求次数、平均阿片类药物消耗量以及接受补救镇痛的患者人数均显著低于ESPB组（P < 0.05）。两组间血流动力学参数无显著差异（P > 0.05）。3例患者发生PTPS（PVB组1例，ESPB组2例），组间差异无统计学意义（P = 0.561）。