在视频辅助胸腔镜手术后的慢性术后疼痛的胸部外周止痛与患者控制的止痛之间的比较:一项前性随机对照研究
Ling Jiang1, Chengyu Wang1, Jie Tong1
1Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Journal of clinical anesthesia
|November 28, 2024
概括
胸部外周麻醉 (TEA) 在视频辅助胸腔镜手术 (VATS) 后显著降低了慢性术后疼痛 (CPSP). 与接受标准护理的患者相比,接受TEA的患者在3个月内患上CPSP的风险降低了71%.
科学领域:
- 麻醉学 麻醉学
- 胸部外科手术 胸部外科手术
- 疼痛管理 疼痛管理
背景情况:
- 慢性术后疼痛 (CPSP) 是胸部手术后的一个重大问题.
- 视频辅助胸腔镜手术 (VATS) 越来越普遍,需要有效的疼痛管理策略.
- 目前的止痛技术可能无法充分防止从急性疼痛过渡到慢性疼痛.
研究的目的:
- 评估胸部外周麻醉和止痛 (TEA) 在减少VATS后CPSP发生率方面的疗效.
- 为了比较TEA与患者控制的静脉注射镇痛 (PCIA) 在预防VATS后的长期疼痛.
- 评估TEA对急性疼痛,神经病痛和VATS后抑郁症的影响.
主要方法:
- 一个单中心,单盲,随机对照试验,涉及231名接受VATS治疗的成年患者.
- 患者随机分配,接受TEA全身麻醉或PCIA全身麻醉.
- 慢性术后疼痛在术后3个月和6个月通过电话随访进行评估.
主要成果:
- 3个月后CPSP的发病率在TEA组 (28.9%) 与PCIA组 (56.4%) 相比显著较低 (P < 0.0001).
- 3个月后发展CPSP的几率比为0.31 (95% CI,0.18-0.54),调整后的OR为0.28 (95% CI,0.16-0.50).
- 在6个月后,TEA组 (14.9%) 与PCIA组 (42.7%) 的CPSP发病率仍然明显较低 (P < 0.0001).
结论:
- 胸腔外围麻醉和止痛是一种有效的策略,可以减少VATS后慢性术后疼痛的发生率.
- 与胸部手术后患者控制的静脉静脉止痛相比,TEA在长期疼痛管理中提供了显著的好处.
- 进一步的研究应该探索TEA对慢性疼痛发展的保护作用的基础机制.
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