心脏外科手术后的胸切除术止痛的连续前块:一个单中心可行性研究
Jonathan G Bailey1, Ayman Hendy1, Victor Neira1
1Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.
British journal of anaesthesia
|January 25, 2025
概括
这项研究发现,由于招募率较低和不良事件较高,对椎切除术疼痛的管镇痛进行较大的试验是不可行的. 有限的数据显示,罗皮瓦卡因和安慰剂组之间的恢复质量没有差异.
科学领域:
- 麻醉学 麻醉学
- 疼痛管理 疼痛管理
- 外科手术的结果
背景情况:
- 胸腔切除术后的疼痛是常见的,需要有效的止痛药.
- 胸腔切除术后连续神经阻塞导管的最佳放置仍然没有定义.
- 骨前面平面 (SAP) 导管止痛是一种潜在的选择,用于骨切割疼痛.
研究的目的:
- 评估一项更大规模的临床试验的可行性,评估SAP导管止痛药用于胸腔切除术后的疼痛.
- 为了比较罗皮瓦卡因与安慰剂在双边SAP导管中治疗胸切割疼痛的疗效.
主要方法:
- 一项双盲试验随机选择了接受心脏手术的患者,通过胸切除术接受双边SAP导管,使用罗皮瓦卡因或安慰剂.
- 通过招募率,协议遵守率,结果测量率和不良事件率来评估可行性.
- 恢复质量 (QoR-15) 通过使用独立的t测试,在不同组之间进行了比较.
主要成果:
- 由于招募率低 (2.4 /月) 和肺胸病率高 (12%),该研究在单一中心被认为是不可行的.
- 在罗皮瓦卡因和安慰剂组之间,没有观察到疼痛,阿片类药物消耗,并发症或恢复质量的显著差异.
- 在3个月后的长期疼痛在两组中都很低.
结论:
- 在这种情况下,单中心试验SAP导管止痛在胸切割疼痛是不可行的.
- 有限的数据表明,用罗皮瓦卡因注入的双边SAP导管治疗胸切割疼痛的恢复质量没有差异.
相关概念视频
Skeletal Muscle Relaxants: Therapeutic Uses
462
Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx...
462
Local Anesthetics: Clinical Application as Spinal Anesthesia
573
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
573
Depolarizing Blockers: Pharmocokinetics
305
Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
305
General Anesthesia: Overview
190
Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
190
Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia
937
Depending on the target organ, local anesthetics (LAs) can be administered via various routes. In surface anesthesia, LAs are applied directly to the surface of the skin or mucous membranes. It is widely used for topical skin numbing before venipuncture or minor surgical procedures. Commonly used surface local anesthetics are lidocaine or benzocaine sprays or creams. Surface anesthesia occurs within 5 minutes and lasts for about 60 minutes. One of the main disadvantages of topical anesthesia is...
937
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
352
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
One of the advantages of...
352


