Richardson J, Sabanathan S, Eng J, Mearns A J, Rogers C, Evans C S, Bembridge J, Majid M R
Department of Anaesthetics, Bradford Royal Infirmary, England.
Ann Thorac Surg. 1993 Feb;55(2):377-80. doi: 10.1016/0003-4975(93)91002-5.
Twenty patients undergoing elective thoracotomy were randomized into two groups, receiving either lumbar epidural morphine (n = 10) or continuous extrapleural intercostal nerve block (n = 10). Subjective pain relief was assessed on a linear visual analogue scale. Pulmonary function (peak expiratory flow rate, forced expiratory volume in 1 second, and forced vital capacity) was measured on the day before operation and daily for 4 days after operation. Pulse oximetry monitoring was used to determine the incidence of hypoxemia. No significant difference was observed between the groups concerning pain relief (except at 28 hours, in favor of the intercostal nerve block group), respiratory performance, or arterial oxygen saturation. Vomiting, pruritus, and urinary retention occurred only in the epidural group, whereas nausea occurred significantly less frequently in the extrapleural group. We conclude that after thoracotomy continuous extrapleural intercostal nerve block is as effective as lumbar epidural morphine in reducing postoperative pain and restoring pulmonary mechanics. Because of the significantly lower complication rates we favor continuous extrapleural intercostal nerve block for postthoracotomy analgesia.
20例行择期开胸手术的患者被随机分为两组，分别接受腰段硬膜外吗啡注射（n = 10）或持续胸膜外肋间神经阻滞（n = 10）。采用线性视觉模拟量表评估主观疼痛缓解情况。在术前一天及术后4天每天测量肺功能（呼气峰值流速、一秒用力呼气量和用力肺活量）。使用脉搏血氧饱和度监测来确定低氧血症的发生率。两组在疼痛缓解（28小时时除外，肋间神经阻滞组更具优势）、呼吸功能或动脉血氧饱和度方面未观察到显著差异。呕吐、瘙痒和尿潴留仅发生在硬膜外组，而胸膜外组恶心的发生率明显较低。我们得出结论，开胸手术后持续胸膜外肋间神经阻滞在减轻术后疼痛和恢复肺力学方面与腰段硬膜外吗啡同样有效。由于并发症发生率显著较低，我们更倾向于采用持续胸膜外肋间神经阻滞进行开胸术后镇痛。
