■尽管微创胸腔镜手术(VATS)得到了广泛应用,此手术后的术后疼痛仍然是一个持续的临床挑战。前锯肌平面(SAP)阻滞是具有良好效果的区域性镇痛技术之一。然而,由于行动持续时间有限,最佳的镇痛往往不是通过单次注射来实现的。我们测试了在术前麻醉下接受常规SAP阻滞的患者是否,在手术后24小时添加第二个SAP阻滞,提高回收质量,降低术后阿片类药物的消耗,并降低慢性疼痛的患病率。
■本研究是一个单一的机构,prospective,随机化,三盲,安慰剂对照研究。从2022年1月至2022年4月接受VATS的90例患者以1:1的比例随机分配,接受超声引导的第二次SAP阻滞,使用15mL0.375%罗哌卡因(SAP阻滞组)或15mL生理盐水(对照组)。两组均接受15mL0.375%罗哌卡因的常规SAP阻滞。主要结果是患者康复质量,在术后第2天(POD2)使用40项恢复质量问卷(QoR-40)进行测量。次要结果包括:静息时的术后疼痛评分,术后阿片类药物的消耗,按患者自控镇痛(PCA)泵按钮的次数,围手术期并发症和不良反应,术后2个月和3个月的慢性疼痛患病率,住院时间(LOS)。
■共有83例患者完成了研究:SAP阻滞组43例,对照组40例。SAP阻滞组患者POD2和POD3的总体QoR-40评分(180.07±11.34,182.09±8.20)明显高于对照组(172.18±6.15,177.50±6.94)(P=0.01,P=0.008)。术后疼痛评分,与对照组相比,SAP阻滞组患者的阿片类药物用量和术后恶心呕吐发生率明显较低。两组患者围手术期并发症及LOS差异无统计学意义。SAP阻滞组和对照组患者术后2个月和3个月的慢性疼痛患病率为16.3%,14%,32.5%,分别为27.5%。
■在接受VATS的患者中,术后24小时应用超声引导下的第二次SAP阻滞改善了术后生活质量,减少阿片类药物的消耗和相关的副作用,并降低了慢性疼痛的患病率。
UNASSIGNED: Despite widespread application of minimally invasive video-assisted thoracic surgery (VATS), postoperative pain following this procedure is still a constant clinical challenge. Serratus anterior plane (SAP) block is one of the regional analgesic techniques with promising outcomes. However, due to the limited duration of action, optimal analgesia is often not achieved with a single injection. We tested whether in patients who have been subjected to routine SAP block under preoperative anesthesia, the addition of a second SAP block 24 hours after surgery, improves quality of recovery, lowers postoperative opioid consumption, and reduces the prevalence of chronic pain.
UNASSIGNED: The present study is a single institutional, prospective, randomized, triple-blinded, placebo-controlled study. Ninety patients undergoing VATS from January 2022 to April 2022 were randomized at 1:1 ratio to receive ultrasound-guided second SAP block with 15 mL 0.375% ropivacaine (SAP block group) or 15 mL normal saline (control group) 24 hours after both groups received routine SAP block with 15 mL 0.375% ropivacaine. The primary outcome was quality of patient recovery, measured using 40-item quality of recovery questionnaire (QoR-40) at postoperative day 2 (POD 2). Secondary outcomes included: postoperative pain scores at rest, postoperative opioid consumptions, number of times that patient controlled analgesia (PCA) pump button was pressed, perioperative complications and adverse effects, prevalence of chronic pain at 2nd and 3rd month postoperatively, and length of hospital stay (LOS).
UNASSIGNED: A total of 83 patients completed the study: 43 patients in SAP block group and 40 patients in the control group. The global QoR-40 scores on POD 2 and POD 3 were significantly higher among SAP block group patients (180.07±11.34, 182.09±8.20) compared with the control group (172.18±6.15, 177.50±6.94) (P=0.01, P=0.008) respectively. Postoperative pain scores, opioid consumptions and incidence of postoperative nausea and vomiting were significantly lower among patients in SAP block group versus control group. There were no statistically significant differences in perioperative complications and LOS between the two groups. The prevalence of chronic pain at the 2nd and 3rd month postoperatively for patients in SAP block group and control group was 16.3%, 14%, and 32.5%, 27.5% respectively.
UNASSIGNED: In patients undergoing VATS, application of ultrasound-guided second SAP block 24 hours after surgery improved postoperative quality of life, reduced opioid consumption and related side effects, and lowered the prevalence of chronic pain.