麻醉重症监护病房开展术后椎旁神经阻滞镇痛对胸外科术后慢性疼痛的影响

Effects of postoperative paraspinal nerve block analgesia on chronic pain after pulmonary surgery in AICU

目的探讨麻醉重症监护病房(AICU)内开展的术后椎旁神经阻滞镇痛对胸外科术后慢性疼痛(PTPS)的影响。方法回顾性分析行胸外科肺部手术患者65例,按照是否进行椎旁神经阻滞镇痛分为未行术后椎旁阻滞镇痛组(NPVB组)37例,及术后椎旁神经阻滞镇痛组(PVB组)28例,统计两组患者年龄、性别、既往慢性病史(高血压、糖尿病、冠心病)、手术名称及手术时间,采用电话回访,依据数字评分法(NRS)表示疼痛强度,依据神经病理性疼痛量表评估疼痛的性质,采用t检验、χ^(2)检验或Fisher精确概率法统计分析数据。结果NPVB组PTPS发生率为43.2%,PVB组PTPS发生率为32.1%,两组间差异无统计学意义(P>0.05);NPVB组神经病理性疼痛发生率为21.6%,PVB组发生率为17.9%,两组间差异无统计学意义(P>0.05);NPVB组严重PTPS(NRS≥3分)发生率为13.5%,PVB组发生率为0.0%,两组间差异有统计学意义(P<0.05)。结论术后椎旁神经阻滞镇痛可显著降低患者严重PTPS(NRS≥3分)的发生率。

Objective To investigate the analgesia effects of postoperative paravertebral blockade(PVB)on chronic pain after thoracic surgery(PTPS)in AICU.Methods A retrospective analysis was performed on 65 patients undergoing thoracic surgery and lung surgery.According to whether PVB analgesia was performed,they were divided into NPVB group(n=37)and PVB group(n=28).Patient age,gender,medical history(high blood pressure,diabetes,coronary heart disease),status of operation and anesthesia were analyzed as possible risk factors.Through the follow-up,we used numerical rating scale and Douleur Neuropathicique 4 questions scale to assess the intensity and the nature of pain,respectively.Statistical analysis was carried out with the t test,chi-square test,and Fisher′s exact test.Results The incidence of PTPS in the NPVB group and PVB group were 43.2%and 32.1%,respectively,demonstrating no significant difference between the two groups(P>0.05).Similarly,the incidence of neuropathic pain displayed no significant difference(P>0.05)between the NPVB group(21.6%)and PVB group(17.9%).Nevertheless,a statistical difference(P<0.05)was found in the incidence of severe PTPS(NRS≥3 points),which were 13.5%and 0.0%in the NPVB group and PVB group,respectively.Conclusion Postoperative paraspinal nerve block analgesia can significantly reduce the incidence of severe PTPS.