单次胸椎旁神经阻滞联合自控静脉镇痛对开胸患者术后急性和慢性疼痛的影响

Effect of single‑dose thoracic paravertebral nerve block combined with patient‑controlled intravenous analgesia on acute and chronic pain in patients undergoing thoracotomy

目的观察单次胸椎旁神经阻滞联合自控静脉镇痛对开胸患者术后急性和慢性疼痛的影响。方法选择行开胸手术的成年患者80例,采用随机数字表法将患者分为两组(每组40例):自控静脉镇痛组(I组)和单次胸椎旁神经阻滞联合自控静脉镇痛组(P组)。I组患者不给予胸椎旁神经阻滞,术毕时给予自控静脉镇痛;P组患者手术开始前在手术切口肋间水平行超声引导下胸椎旁神经阻滞,注入0.3%罗哌卡因复合地塞米松10 mg共20 ml,术毕时也给予自控静脉镇痛。记录两组患者术后6、24、48、72 h静息和咳嗽时数字分级评分法(Numeral Rating Scale,NRS)疼痛评分,术后l、3、6、12个月时对患者进行电话随访,询问是否存在静息时伤口疼痛以及NRS疼痛评分。结果P组术后6、24、48、72 h静息和咳嗽时NRS疼痛评分低于I组(P<0.05)。P组术后1个月和术后3个月静息时NRS疼痛评分低于I组(P<0.05)。两组患者术后6个月和术后12个月静息时NRS疼痛评分差异无统计学意义(P>0.05)。两组患者术后l、3、6、12个月静息时慢性疼痛发生率差异无统计学意义(P>0.05)。结论与单纯使用自控静脉镇痛比较,单次胸椎旁神经阻滞联合自控静脉镇痛不能明显降低开胸患者l、3、6、12个月静息时慢性疼痛发生率,但可缓解术后6、24、48、72 h时急性疼痛程度和术后1个月、术后3个月时慢性疼痛程度。

Objective To evaluate the effect of single‑dose thoracic paravertebral nerve block combined with patient‑controlled intravenous analgesia on acute and chronic pain in patients undergoing thoracotomy.Methods According to the random number table method,80 patients undergoing thoracotomy were divided into two groups(n=40):a patient‑controlled intravenous analgesia group(group I)and a single‑dose thoracic paravertebral nerve block combined with patient‑controlled intravenous analgesia group(group P).In group I,patients were not given thoracic paravertebral nerve block,and patients were given a patient‑controlled intravenous analgesia pump at the end of operation.In group P,thoracic paravertebral nerve block was performed on the proposed thoracic level of skin incision under the guidance of ultrasound before operation,0.3%ropivacaine plus 10 mg dexamethasone 20 ml was administered.Patient‑controlled intrave‑nous analgesia pump was also used at the end of operation in group P.The Numerical Rating Scale(NRS)scores at rest and coughing 6,24,48,72 h after operation were recorded.The incidence and intensity of chronic pain at rest were evaluated 1,3,6,12 months after opera‑tion.Results Patients in group P had significantly lower NRS scores at rest and coughing than those in group I 6,24,48,72 h after oper‑ation(P<0.05).Group P showed significantly lower NRS scores at rest than group I 1 and 3 months after operation(P<0.05).There was no statistical difference in NRS scores at rest between group P and group I 6 and 12 months after operation(P>0.05).There was no statistical difference in the incidence of chronic pain at rest between group P and group I 1,3,6,12 months after operation(P>0.05).Conclusions Compared with patient‑controlled intravenous analgesia,single‑dose thoracic paravertebral nerve block combined with patient‑controlled intravenous analgesia cannot significantly reduce the incidence of chronic pain at rest 1,3,6,12 months after operation,but can improve acute pain 6,24,48,72 h after operation and chronic pain 1 and 3 months after operation in patients undergoing thoracotomy.