超声引导下胸椎旁神经阻滞联合氢吗啡酮对胸腔镜手术术后镇痛及炎症反应的影响：一项随机对照试验
The effect of ultrasound-guided thoracic paravertebral nerve block combined with hydromorphone on postoperative analgesia and inflammatory response in thoracoscopic surgery: a randomized controlled trial.
作者信息
Zeng Lin, Yu Xiaoxue, Yang Ting, Liao Jing, Ouyang Yinghui
机构信息
Department of Anesthesiology, Shifang People's Hospital, Shifang, Sichuan, China.
出版信息
Front Med (Lausanne). 2025 Jul 25;12:1587477. doi: 10.3389/fmed.2025.1587477. eCollection 2025.
OBJECTIVE
This study aims to explore the effects of a multimodal postoperative analgesia regimen of ultrasound-guided thoracic paravertebral block (UTPB) combined with hydromorphone patient-controlled intravenous analgesia (PCIA) on postoperative analgesia, early recovery, and traumatic inflammatory response in patients undergoing thoracoscopy surgery, providing a basis for clinical application.
METHODS
In this single-blind, randomized controlled trial (RCT), we enrolled 64 patients scheduled for thoracoscopic lobectomy of the lung. The patients were randomly assigned into two groups of UTPB combined with hydromorphone PCIA group (T group) and hydromorphone PCIA group (H group) according to the random number table method. T group underwent UTPB with ropivacaine before induction of general anesthesia. H group is the control group. Both groups underwent PCIA after surgery, with the analgesic formula being 50 μg/kg of hydromorphone. The analgesic solution is prepared with 100 mL of sodium chloride injection, a background dose of 2.0 mL/h, a patient-controlled analgesia dose of 2 mL, and a locking time of 30 min.
RESULTS
Compared with H group, T group showed a significant decrease in visual analog scale (VAS) scores and an increase in bruggrmann comfort scale (BCS) scores within 8 h after surgery, and a decrease in opioid analgesic doses during and within 8 h after surgery. The levels of serum C-reactive protein (CRP), Interleukin-6 (IL-6), and tumor necrosis factor (TNF-α) in T group were lower than those in H group at 24 h after surgery. The first time patients in T group got out of bed after surgery was earlier than that in H group. Two groups of patients had no serious adverse reactions.
CONCLUSION
Ultrasound-guided thoracic paravertebral block combined with hydromorphone PCIA can achieve good analgesic effects in thoracoscopic lobectomy surgery. It can reduce the amount of opioid drugs used during the perioperative period, alleviate the body's inflammatory response, and promote rapid recovery of patients. It has clinical application value.
CLINICAL TRIAL REGISTRATION
https://www.chictr.org.cn/showproj.html?proj=201650, identifier ChiCTR2300074082.
目的
本研究旨在探讨超声引导下胸椎旁神经阻滞（UTPB）联合氢吗啡酮患者自控静脉镇痛（PCIA）的多模式术后镇痛方案对胸腔镜手术患者术后镇痛、早期恢复及创伤性炎症反应的影响，为临床应用提供依据。
方法
在这项单盲随机对照试验（RCT）中，我们纳入了64例计划行肺叶切除术的胸腔镜手术患者。根据随机数字表法将患者随机分为UTPB联合氢吗啡酮PCIA组（T组）和氢吗啡酮PCIA组（H组）。T组在全身麻醉诱导前采用罗哌卡因进行UTPB。H组为对照组。两组术后均行PCIA，镇痛配方为氢吗啡酮50μg/kg。镇痛液用100mL氯化钠注射液配制，背景剂量为2.0mL/h，患者自控镇痛剂量为2mL，锁定时间为30分钟。
结果
与H组相比，T组术后8小时内视觉模拟评分（VAS）显著降低，布氏舒适度评分（BCS）升高，且术后及术后8小时内阿片类镇痛药物剂量减少。术后24小时T组血清C反应蛋白（CRP）、白细胞介素-6（IL-6）和肿瘤坏死因子（TNF-α）水平低于H组。T组患者术后首次下床时间早于H组。两组患者均未出现严重不良反应。
结论
超声引导下胸椎旁神经阻滞联合氢吗啡酮PCIA在胸腔镜肺叶切除术中可取得良好的镇痛效果。它可减少围手术期阿片类药物用量，减轻机体炎症反应，促进患者快速康复。具有临床应用价值。
临床试验注册
https://www.chictr.org.cn/showproj.html?proj=201650，标识符ChiCTR2300074082。
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