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Abstract：
This study investigated whether the divided method of multi-level intercostal nerve block (ML-ICB) could reduce the ropivacaine dose required during thoracoscopic pulmonary resection, while maintaining the resting postoperative pain scores.
This retrospective, single-cohort study enrolled 241 patients who underwent thoracoscopic pulmonary resection for malignant tumors between October 2020 and March 2022 at a cancer hospital in Japan. ML-ICB was performed by surgeons under direct vision. The differences in intraoperative anesthetic use and postoperative pain-related variables at the beginning and end of surgery between group A (single-shot ML-ICB; 0.75% ropivacaine, 20 mL at the end of the surgery) and group B (divided ML-ICB, performed at the beginning and end of surgery; 0.25% ropivacaine, 30 mL total) were assessed. The numerical rating scale (NRS) was used to evaluate pain 1 h and 24 h postoperatively.
Intraoperative remifentanil use was significantly lower in group B (14.4 ± 6.4 μg/kg/h) than in group A (16.7 ± 8.4 μg/kg/h) (P = 0.02). The proportion of patients with NRS scores of 0 to 3 at 24 h was significantly higher in group B (85.4%, 106/124) than in group A (73.5%, 86/117) (P = 0.02). The proportion of patients not requiring postoperative intravenous rescue drugs was significantly higher in group B (78.2%, 97/124) than in group A (61.5%, 72/117) (P < 0.01).
The divided method of ML-ICB could reduce the intraoperative remifentanil dose, decrease the postoperative pain score at 24 h, and curtail postoperative intravenous rescue drug use, despite using half the total ropivacaine dose intraoperatively.
This retrospective, single-cohort study enrolled 241 patients who underwent thoracoscopic pulmonary resection for malignant tumors between October 2020 and March 2022 at a cancer hospital in Japan. ML-ICB was performed by surgeons under direct vision. The differences in intraoperative anesthetic use and postoperative pain-related variables at the beginning and end of surgery between group A (single-shot ML-ICB; 0.75% ropivacaine, 20 mL at the end of the surgery) and group B (divided ML-ICB, performed at the beginning and end of surgery; 0.25% ropivacaine, 30 mL total) were assessed. The numerical rating scale (NRS) was used to evaluate pain 1 h and 24 h postoperatively.
Intraoperative remifentanil use was significantly lower in group B (14.4 ± 6.4 μg/kg/h) than in group A (16.7 ± 8.4 μg/kg/h) (P = 0.02). The proportion of patients with NRS scores of 0 to 3 at 24 h was significantly higher in group B (85.4%, 106/124) than in group A (73.5%, 86/117) (P = 0.02). The proportion of patients not requiring postoperative intravenous rescue drugs was significantly higher in group B (78.2%, 97/124) than in group A (61.5%, 72/117) (P < 0.01).
The divided method of ML-ICB could reduce the intraoperative remifentanil dose, decrease the postoperative pain score at 24 h, and curtail postoperative intravenous rescue drug use, despite using half the total ropivacaine dose intraoperatively.
摘要：
目的：本研究探讨了多级肋间神经阻滞（ML-ICB）的分割方法是否可以减少胸腔镜肺切除术中所需的罗哌卡因剂量。同时保持静息术后疼痛评分。
方法：本回顾性研究，单队列研究纳入了2020年10月至2022年3月期间在日本一家肿瘤医院接受胸腔镜下恶性肿瘤肺切除术的241例患者.ML-ICB由外科医生在直视下进行。A组手术开始和结束时的术中麻醉药使用和术后疼痛相关变量的差异（单次注射ML-ICB；0.75％罗哌卡因，手术结束时20mL）和B组（分为ML-ICB，在手术开始和结束时进行；0.25%罗哌卡因，总共30mL)进行评估。使用数字评定量表（NRS）评估术后1h和24h的疼痛。
结果：术中瑞芬太尼用量B组（14.4±6.4μg/kg/h）明显低于A组（16.7±8.4μg/kg/h）（P=0.02）。B组24hNRS评分为0~3分的患者比例明显高于B组(85.4%,106/124）比A组（73.5％，86/117)(P=0.02)。B组术后不需要静脉抢救药物的患者比例明显高于B组(78.2%,97/124）比A组（61.5%，72/117)(P<0.01)。
结论：ML-ICB的分割方法可以减少术中瑞芬太尼的剂量，降低术后24h疼痛评分，减少术后静脉抢救药物的使用，尽管术中使用了罗哌卡因总量的一半。
方法：本回顾性研究，单队列研究纳入了2020年10月至2022年3月期间在日本一家肿瘤医院接受胸腔镜下恶性肿瘤肺切除术的241例患者.ML-ICB由外科医生在直视下进行。A组手术开始和结束时的术中麻醉药使用和术后疼痛相关变量的差异（单次注射ML-ICB；0.75％罗哌卡因，手术结束时20mL）和B组（分为ML-ICB，在手术开始和结束时进行；0.25%罗哌卡因，总共30mL)进行评估。使用数字评定量表（NRS）评估术后1h和24h的疼痛。
结果：术中瑞芬太尼用量B组（14.4±6.4μg/kg/h）明显低于A组（16.7±8.4μg/kg/h）（P=0.02）。B组24hNRS评分为0~3分的患者比例明显高于B组(85.4%,106/124）比A组（73.5％，86/117)(P=0.02)。B组术后不需要静脉抢救药物的患者比例明显高于B组(78.2%,97/124）比A组（61.5%，72/117)(P<0.01)。
结论：ML-ICB的分割方法可以减少术中瑞芬太尼的剂量，降低术后24h疼痛评分，减少术后静脉抢救药物的使用，尽管术中使用了罗哌卡因总量的一半。
