Clinical study of pain control with continuous intercostal nerve block after thoracotomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Zheng ¹ , ZHU Hong ¹ , REN Jie ¹ , LIU Wen ¹ , YANG Yangang ¹ , ZHANG Lin ¹ , YANG Wei ¹ , ZHANG Yonghong ² ,  LUO Jiwen ¹

1. Department of Cardiothoracic Surgery, Mianyang Central Hospital, Mianyang, 621000, Sichuan, P.R.China;
2. Department of Anesthesiology, Mianyang Central Hospital, Mianyang, 621000, Sichuan, P.R.China;

Corresponding author：

LUO Jiwen, Email: kaixinluojiwen@126.com

Keywords：

Continuous intercostal nerve block; thoracotomy; multimodal analgesia; treatment

DOI：

10.7507/1007-4848.201910071

Video：

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Objective To determine the effectiveness of continuous intercostal nerve block for pain relief after thoracotomy.Methods From November 2017 to October 2018, 120 patients who received thoracotomy procedure in our hospital were collected, including 60 males and 60 females aged 40-77 (58.10±7.00) years. The patients were randomly allocated into three groups by digital table including a continuous intercostal nerve block group (group A, n=40), a single intercostal nerve block group (group B, n=40), and an epidural analgesia group (group C, n=40). All the groups received the same basic analgesia. The pain scores and rescue analgesic doses were compared.Results On postoperative day (POD) 0, all groups achieved effective pain control, and the visual analogue score was 2.02±0.39 points in the group A, 2.13±0.75 points in the group B and 2.03±0.69 points in the group C (P>0.05). On POD 0-2 and POD 3-4 (without basement analgesia), there was no significant difference between the group A and group C in the pain scores (2.08±0.28 points vs. 1.93±0.53 points, 3.20±0.53 points vs. 3.46±0.47 points, P>0.05), however, the difference between POD 0-2 and POD 3-4 in each group was stastically different (group A, 2.08±0.28 points vs. 3.20±0.53 points; group B, 2.42±0.73 points vs. 5.45±0.99 points; group C 1.93±0.53 points vs. 3.46±0.47 points, P<0.05). In terms of the rescue analgesic doses, there was no significant difference between the group A and group C (220.00±64.08 mg vs. 225.38±78.85 mg, P>0.05); it was larger in the group B than that in the group A and group C (343.33±119.56 mg vs. 220.00±64.08 mg; 343.33±119.56 mg vs. 225.38±78.85 mg, P<0.05).Conclusion Multimodal analgesia is an optimal choice in the initial stage after thoracotomy surgery. Continuous intercostal nerve block is an effective way to pain management in patients with thoracotomy.

Citation： LIU Zheng, ZHU Hong, REN Jie, LIU Wen, YANG Yangang, ZHANG Lin, YANG Wei, ZHANG Yonghong, LUO Jiwen. Clinical study of pain control with continuous intercostal nerve block after thoracotomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(7): 784-788. doi: 10.7507/1007-4848.201910071 Copy

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12.	全金, 张军, 蔡铁良, 等. 超低浓度罗哌卡因硬膜外阻滞复合全麻在老年直肠癌患者手术中的应用. 国际医药卫生导报, 2019, 25(9): 1390-1393.
13.	江志伟, 周嘉晖, 成汇. 多模式镇痛在加速康复外科中的作用. 山东大学学报(医学版), 2019, 57(9): 1-4, 11.
14.	Paneta M, Waring WS. Literature review of the evidence regarding intravenous lipid administration in drug-induced cardiotoxicity. Expert Rev Clin Pharmacol, 2019, 12(7): 591-602.
15.	Chiu KM, Lin TY, Lee MY, et al. Ropivacaine protects against memory impairment and hippocampal damage in a rat neurodegeneration model. Pharmacology, 2018, 102(5-6): 307-315.
16.	张睿, 史敏科, 王小雨, 等. 不同浓度罗哌卡因肋间神经阻滞在开胸手术后早期镇痛中的应用. 临床麻醉学杂志, 2015, 31(4): 323-325.
17.	陆丽虹, 缪长虹, 侯文婷, 等. 地塞米松对罗哌卡因行肋间神经阻滞效果的影响. 复旦学报(医学版), 2019, 46(4): 515-518.
18.	李硕, 王哲, 张广健, 等. 罗哌卡因肋间神经阻滞在胸腔镜术后多模式镇痛作用. 西北药学杂志, 2018, 33(3): 385-388.

1. Reddi D. Preventing chronic postoperative pain. Anaesthesia, 2016, 71(Suppl 1): 64-71.
2. Neil MJ, Bannister J. When acute pain becomes chronic. Anaesthesia, 2015, 70(7): 779-783.
3. Rogers ML, Henderson L, Mahajan RP, et al. Preliminary findings in the neurophysiological assessment of intercostal nerve injury during thoracotomy. Eur J Cardiothorac Surg, 2002, 21(2): 298-301.
4. Pozek JP, Beausang D, Baratta JL, et al. The acute to chronic pain transition: can chronic pain be prevented? Med Clin North Am, 2016, 100(1): 17-30.
5. Werner MU, Kongsgaard UE. Defining persistent post-surgical pain: is an update required? Br J Anaesth, 2014, 113(1): 1-4.
6. Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet, 2006, 367(9522): 1618-1625.
7. Bendixen M, Jørgensen OD, Kronborg C, et al. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled trial. Lancet Oncol, 2016, 17(6): 836-844.
8. Yeung JH, Gates S, Naidu BV, et al. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy. Cochrane Database Syst Rev, 2016, 2(2): CD009121.
9. 苗良生, 钟永慧. 全麻复合硬膜外阻滞对胸腔镜肺癌根治术后患者镇痛效果的影响. 实用癌症杂志, 2018, 33(10): 1679-1682.
10. Biswas S, Verma R, Bhatia VK, et al. Comparison between thoracic epidural block and thoracic paravertebral block for post thoracotomy pain relief. J Clin Diagn Res, 2016, 10(9): U8-U12.
11. Su J, Tian JH, Gao XX, et al. Multimodal analgesic analgesia in patients with obstructive sleep apnea hypopnea syndrome with multiple planar surgery. J Clin Otorhinolaryngol Head Neck Surg, 2018, 32(11): 850-853.
12. 全金, 张军, 蔡铁良, 等. 超低浓度罗哌卡因硬膜外阻滞复合全麻在老年直肠癌患者手术中的应用. 国际医药卫生导报, 2019, 25(9): 1390-1393.
13. 江志伟, 周嘉晖, 成汇. 多模式镇痛在加速康复外科中的作用. 山东大学学报(医学版), 2019, 57(9): 1-4, 11.
14. Paneta M, Waring WS. Literature review of the evidence regarding intravenous lipid administration in drug-induced cardiotoxicity. Expert Rev Clin Pharmacol, 2019, 12(7): 591-602.
15. Chiu KM, Lin TY, Lee MY, et al. Ropivacaine protects against memory impairment and hippocampal damage in a rat neurodegeneration model. Pharmacology, 2018, 102(5-6): 307-315.
16. 张睿, 史敏科, 王小雨, 等. 不同浓度罗哌卡因肋间神经阻滞在开胸手术后早期镇痛中的应用. 临床麻醉学杂志, 2015, 31(4): 323-325.
17. 陆丽虹, 缪长虹, 侯文婷, 等. 地塞米松对罗哌卡因行肋间神经阻滞效果的影响. 复旦学报(医学版), 2019, 46(4): 515-518.
18. 李硕, 王哲, 张广健, 等. 罗哌卡因肋间神经阻滞在胸腔镜术后多模式镇痛作用. 西北药学杂志, 2018, 33(3): 385-388.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical study of pain control with continuous intercostal nerve block after thoracotomy

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