Comparison of Thoracoscopy-Guided Thoracic Paravertebral Block and Ultrasound-Guided Thoracic Paravertebral Block in Postoperative Analgesia of Thoracoscopic Lung Cancer Radical Surgery: A Randomized Controlled Trial

IF 4.1 2区医学 Q1 CLINICAL NEUROLOGY Pain and Therapy Pub Date : 2024-04-09 DOI:10.1007/s40122-024-00593-7

Xia Xu, Ying-xin Xie, Meng Zhang, Jian-hui Du, Jin-xian He, Li-hong Hu

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Abstract

Introduction

Ultrasound-guided thoracic paravertebral block (UTPB) is widely used for postoperative analgesia in thoracic surgery. However, it has many disadvantages. Thoracoscopy-guided thoracic paravertebral block (TTPB) is a new technique for thoracic paravertebral block (TPB). In this study, we compared the use of TTPB and UTPB for pain management after thoracoscopic radical surgery for lung cancer.

Methods

In total, 80 patients were randomly divided 1:1 into the UTPB group and the TTPB group. The surgical time of TPB, the success rate of the first puncture, block segment range, visual analog scale (VAS) scores at 2, 6, 12, 24, and 48 h post operation, and the incidence of postoperative adverse reactions were compared between the two groups.

Results

The surgical time of TPB was significantly shorter in the TTPB group than in the UTPB group (2.2 ± 0.3 vs. 5.7 ± 1.7 min, t = − 12.411, P < 0.001). The success rate of the first puncture and the sensory block segment were significantly higher in the TTPB group than in the UTPB group (100% vs. 76.9%, χ² = 8.309, P < 0.001; 6.5 ± 1.2 vs. 5.1 ± 1.3 levels, t = − 5.306, P < 0.001, respectively). The VAS scores were significantly higher during rest and coughing at 48 h post operation than at 2, 6, 12, and 24 h post operation in the TTPB group. The VAS scores were significantly lower during rest and coughing at 12 and 24 h post operation in the TTPB group than in the UTPB group (rest: 2.5 ± 0.4 vs. 3.4 ± 0.6, t = 7.325, P < 0.001; 2.5 ± 0.5 vs. 3.5 ± 0.6, t = 7.885, P < 0.001; coughing: 3.4 ± 0.6 vs. 4.2 ± 0.7, t = 5.057, P < 0.001; 3.4 ± 0.6 vs. 4.2 ± 0.8, t = 4.625, P < 0.001, respectively). No significant difference was observed in terms of postoperative adverse reactions between the two groups.

Conclusions

Compared with UTPB, TTPB shows advantages, such as simpler and more convenient surgery, shorter surgical time, a higher success rate of the first puncture, wider block segments, and superior analgesic effect. TTPB can effectively reduce postoperative pain due to thoracoscopic lung cancer radical surgery.

Trial Registration

https://www.chictr.org.cn, identifier ChiCTR2300072005, prospectively registered on 31/05/2023.

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胸腔镜引导下胸椎旁阻滞与超声引导下胸椎旁阻滞在胸腔镜肺癌根治术术后镇痛中的比较：随机对照试验

导言超声引导下胸椎旁阻滞（UTPB）被广泛用于胸外科手术的术后镇痛。然而，它也有许多缺点。胸腔镜引导下胸椎旁阻滞（TTPB）是胸椎旁阻滞（TPB）的一种新技术。本研究比较了 TTPB 和 UTPB 在胸腔镜肺癌根治术后疼痛治疗中的应用。结果 TTPB 组的手术时间明显短于 UTPB 组（2.2 ± 0.3 vs. 5.7 ± 1.7 min，t = - 12.411，P < 0.001）。UTPB组的首次穿刺成功率和感觉阻滞段明显高于UTPB组（分别为100% vs. 76.9%，χ2 = 8.309，P < 0.001；6.5 ± 1.2 vs. 5.1 ± 1.3水平，t = - 5.306，P < 0.001）。TTPB 组术后 48 小时休息和咳嗽时的 VAS 评分明显高于术后 2、6、12 和 24 小时。UTPB组术后12和24小时休息和咳嗽时的VAS评分明显低于UTPB组（休息：2.5 ± 0.4 vs. 3.4 ± 0.6，t = 7.325，P < 0.001; 2.5 ± 0.5 vs. 3.5 ± 0.6，t = 7.885，P <；0.001；咳嗽：分别为 3.4 ± 0.6 vs. 4.2 ± 0.7，t = 5.057，P <；0.001；3.4 ± 0.6 vs. 4.2 ± 0.8，t = 4.625，P <；0.001）。结论与UTPB相比，UTPB具有手术简单方便、手术时间短、首次穿刺成功率高、阻滞区段宽、镇痛效果好等优点。TTPB可有效减轻胸腔镜肺癌根治术的术后疼痛。试验注册https://www.chictr.org.cn，标识符为ChiCTR2300072005，前瞻性注册日期为2023年5月31日。

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来源期刊

Pain and Therapy CLINICAL NEUROLOGY-

CiteScore

6.60

自引率

5.00%

发文量

110

审稿时长

6 weeks

期刊介绍： Pain and Therapy is an international, open access, peer-reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of pain therapies and pain-related devices. Studies relating to diagnosis, pharmacoeconomics, public health, quality of life, and patient care, management, and education are also encouraged. Areas of focus include, but are not limited to, acute pain, cancer pain, chronic pain, headache and migraine, neuropathic pain, opioids, palliative care and pain ethics, peri- and post-operative pain as well as rheumatic pain and fibromyalgia. The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports, trial protocols, short communications such as commentaries and editorials, and letters. The journal is read by a global audience and receives submissions from around the world. Pain and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.