PDF(Pubmed)
Abstract：
The letter to the editor was written in response to \"The effect of ultrasound-guided intercostal nerve block on postoperative analgesia in thoracoscopic surgery: a randomized, double-blinded, clinical trial\", which was recently published by Li et al. (J Cardiothorac Surg 18(1):128, 2023). In this article, Li et al. showed that addition of a preoperative intercostal nerve block to the multimodal analgesic strategy significantly reduced the pain scores within 48 h after surgery. However, we noted several issues in this study that were not well addressed. They were no use of a standard opioid-sparing multimodal analgesic strategy recommended in the current Enhanced Recovery After Surgery protocols for thoracic surgery, the lack of clear description for reasonable selection of rescue analgesics, the interpretion of between-group differences in the postoperative pain scores based on only statistical differences rather than clinically meaningful differences, inclusion of patients who were not blinded to study intervention, not reporting cumulative opioid consumption and complications of intercostal nerve block. We believe that clarification of these issues is not only useful for improving design quality of randomized clinical trials which assess postoperative analgesic efficacy of nerve blocks, but also is helpful for the readers who want to use an opioid-sparing multimodal protocol including a nerve block in patients undergoing thoracoscopic surgery.
摘要：
写给编辑的信是为了回应“超声引导下肋间神经阻滞对胸腔镜手术术后镇痛的影响：随机，双盲,临床试验\“，最近由Li等人发表。(心胸外科18(1):128,2023)。在这篇文章中,李等人。结果表明，在多模式镇痛策略中添加术前肋间神经阻滞可显着降低术后48h内的疼痛评分。然而,我们注意到这项研究中的几个问题没有得到很好的解决。他们没有使用标准的阿片类药物保留多模式镇痛策略，推荐在当前的胸外科手术后增强恢复方案中，对抢救镇痛药的合理选择缺乏明确的描述，对术后疼痛评分的组间差异的解释仅基于统计学差异而非临床意义差异，纳入未蒙蔽研究干预的患者，未报告累积阿片类药物消耗和肋间神经阻滞并发症。我们认为，这些问题的澄清不仅有助于提高随机临床试验的设计质量，评估神经阻滞术后镇痛效果，但对于希望使用阿片类药物保留多模式方案的读者也很有帮助，包括在接受胸腔镜手术的患者中进行神经阻滞。
