Kaiser A M, Zollinger A, De Lorenzi D, Largiadèr F, Weder W
Department of Surgery and Institute for Anesthesiology, University Hospital, Zürich, Switzerland.
Ann Thorac Surg. 1998 Aug;66(2):367-72. doi: 10.1016/s0003-4975(98)00448-2.
Thoracic epidural analgesia is considered the method of choice for postthoracotomy analgesia, but it is not suitable for every patient and is associated with some risks and side effects. We therefore evaluated the effects of an extrapleural intercostal analgesia as an alternative to thoracic epidural analgesia.
In a prospective, randomized study, pain control, recovery of ventilatory function, and pulmonary complications were analyzed in patients undergoing elective lobectomy or bilobectomy. Two groups of 15 patients each were compared: one received a continuous extrapleural intercostal nerve blockade (T3 through T6) with bupivacaine through an indwelling catheter, the other was administered a combination of local anesthetics (bupivacaine) and opioid analgesics (fentanyl) through a thoracic epidural catheter.
Both techniques were safe and highly effective in terms of pain relief and recovery of postoperative pulmonary function. However, minor differences were observed that, together with practical benefits, would favor extrapleural intercostal analgesia.
These results led us to suggest that extrapleural intercostal analgesia might be a valuable alternative to thoracic epidural analgesia for pain control after thoracotomy and should particularly be considered in patients who do not qualify for thoracic epidural analgesia.
胸段硬膜外镇痛被认为是开胸术后镇痛的首选方法，但并非适用于所有患者，且存在一些风险和副作用。因此，我们评估了胸膜外肋间镇痛作为胸段硬膜外镇痛替代方法的效果。
在一项前瞻性随机研究中，对接受择期肺叶切除术或双肺叶切除术的患者的疼痛控制、通气功能恢复及肺部并发症进行了分析。比较了两组各15例患者：一组通过留置导管用布比卡因进行连续胸膜外肋间神经阻滞（T3至T6），另一组通过胸段硬膜外导管给予局部麻醉药（布比卡因）和阿片类镇痛药（芬太尼）联合应用。
就疼痛缓解和术后肺功能恢复而言，两种技术均安全且高效。然而，观察到一些细微差异，综合实际益处，胸膜外肋间镇痛更具优势。
这些结果使我们认为，胸膜外肋间镇痛可能是开胸术后疼痛控制的一种有价值的胸段硬膜外镇痛替代方法，对于不符合胸段硬膜外镇痛条件的患者尤其应予以考虑。
