肺胸外科手术后的疼痛治疗:肋间间神经阻断或胸部外周止痛
Louisa N Spaans1,2,3, Quirine C A van Steenwijk1, Adelina Seiranjan1
1Department of Surgery, Maxima Medical Center, Eindhoven, Netherlands.
Interdisciplinary cardiovascular and thoracic surgery
|November 9, 2023
概括
肋间神经阻断为肺胸外科手术患者提供与胸部外围止痛疗法相比较的疼痛控制,可改善运动能力. 这种局部区域止痛可能是一个可行的替代方案,尽管需要进一步的随机研究.
科学领域:
- 胸部外科手术 胸部外科手术
- 疼痛管理 疼痛管理
- 区域麻醉地区麻醉
背景情况:
- 肺胸部的视频辅助胸腔镜手术 (VATS) 需要有效的止痛.
- 一次射击间肋间神经阻塞 (ICB) 与胸部外周止痛疗法 (TEA) 对VATS疼痛的作用尚不清楚.
研究的目的:
- 为了比较ICB和TEA在疼痛控制和增强肺胸炎VATS后恢复的有效性.
- 评估ICB作为局部区域止痛替代品的风险和益处.
主要方法:
- 追溯多中心分析与倾向性得分匹配.
- 在218名为肺胸部进行VATS的患者中,ICB与TEA的比较.
- 主要结局:疼痛得分的比例≥4直到术后的第3天. 二次结果:阿片类药物使用,停留时间长,流动性,并发症,复发.
主要成果:
- 在ICB和TEA之间疼痛分数≥4的比例没有显著差异 (11.1%与14.3%).
- ICB组的停留时间较短 (3天与4天相比),流动性有所改善.
- 在手术后,TEA组需要更多额外的阿片类药物;ICB的早期疼痛更高,TEA的晚期 (反弹) 疼痛更高.
结论:
- 肋间间神经阻塞在VATS肺胸部的多式设置中提供与胸部外周止痛疗法相比较的疼痛控制.
- ICB与改善患者流动性和更短的住院时间有关.
- 推随机试验来证实这些发现.
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