Clinical study on multimodal analgesia after thoracoscopic segmentectomy

doi:10.3877/cma.j.issn.2095-8773.2020.01.005

Abstract

Abstract:

Objective

To observe and analyze the effect and safety of multimodal analgesia after thoracoscopic segmentectomy.

Methods

Patients who underwent single-operator-orifice thoracoscopic segmentectomy under general anesthesia were selected and divided into control group (PCIA analgesia) and test group (multimodal analgesia) according to the operation time order alternately. The control group was only given an intravenous analgesic pump for pain relief after surgery, and the patients could press the analgesic pump for additional dose when the pain was obvious. If the pain did not improve, an additional hypodermic injection of morphine would be given. The experimental group adopted an intercostal neuroprotective strategy during surgical incision and suture incision. After intrathoracic surgery, thoracoscopic intercostal nerve block was performed, lidocaine was sprayed in the chest, and postoperative intravenous analgesia pump was given to relieve pain as in the control group. The pain PHPS scores of the two groups were recorded at 6 time points at 6h, 12h, 18h, 24h, 36h and 48h after surgery. The PHPS scores, the times of pressing the analgesic pump , the times of additional morphine injection within 0-24 hours and 24-48 hours after the operation, the postoperative hospital stay, the incidence of drug-related adverse reactions of anaesthesia, and the complication rate were recorded and compared between the two groups.

Results

41 patients were included in each group, and there were no statistically significant differences in gender, height, weight, location of the removed lung segment, operation time and other basic conditions (P>0.05). The PHPS scores at 6, 12, 18 and 24 h after operation in the experimental group were significantly lower than those in the control group (P<0.05). The times of pressing PCIA and injecting morphine at 0-24h and 24-48h after the operation were also significantly lower than those in the control group (P<0.05). There were no statistically significant differences in PHPS scores at 36h and 48h after surgery, times of morphine injection at 24-48 h after surgery, postoperative hospital stay, incidence of drug-related side effects and complications (P>0.05).

Conclusions

After thoracoscopic segmentectomy, the above multimodal analgesia was better than intravenous analgesia pump analgesia, and it was simple to implement and suitable for clinical promotion.

Key words: Thoracoscopy, Multimodal analgesia, Intercostal nerve block, Intercostal nerve protection, Segmentectomy

Fang Mi, Min Liu, Shuyun Zhang, Hanqing Tang, Meirong Qiu, Baohua Lyu, XiaoMei Huang, Longcai Zhuo. Clinical study on multimodal analgesia after thoracoscopic segmentectomy[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2020, 07(01): 30-35.

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References 15

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项目		试验组(N＝41)	对照组(N＝41)	χ² /t值	P值
性别(n)		?	?	0.195	0.525
?	男性	19	21	?	?
?	女性	22	20	?	?
年龄(岁，±s)		59.24±8.642	58.34±8.463	0.478	0.634
身高(cm，±s)		167.52±8.77	168.60±9.24	-0.539	0.591
体重(kg，±s)		66.20±9.25	69.54±9.44	-1.618	0.110
手术时间(min，±s)		140.05±23.41	139.17±21.62	-0.176	0.860
手术切除肺段(n)		?	?	4.176	0.964
?	右上肺尖段	4	5	?	?
?	右上肺后段	4	5	?	?
?	右上肺前段	5	4	?	?
?	右下肺背段	5	5	?	?
?	右下肺前基底段	1	3	?	?
?	右下肺外基底段	1	2	?	?
?	右下肺后基底段	2	3	?	?
?	左上肺尖后段	4	4	?	?
?	左上肺前段	3	4	?	?
?	左上肺下舌段	5	3	?	?
?	左下肺背段	4	2	?	?
?	左下肺前基底段	3	1	?	?

项目		试验组(N＝41)	对照组(N＝41)	χ² /t值	P值
性别(n)		?	?	0.195	0.525
?	男性	19	21	?	?
?	女性	22	20	?	?
年龄(岁，±s)		59.24±8.642	58.34±8.463	0.478	0.634
身高(cm，±s)		167.52±8.77	168.60±9.24	-0.539	0.591
体重(kg，±s)		66.20±9.25	69.54±9.44	-1.618	0.110
手术时间(min，±s)		140.05±23.41	139.17±21.62	-0.176	0.860
手术切除肺段(n)		?	?	4.176	0.964
?	右上肺尖段	4	5	?	?
?	右上肺后段	4	5	?	?
?	右上肺前段	5	4	?	?
?	右下肺背段	5	5	?	?
?	右下肺前基底段	1	3	?	?
?	右下肺外基底段	1	2	?	?
?	右下肺后基底段	2	3	?	?
?	左上肺尖后段	4	4	?	?
?	左上肺前段	3	4	?	?
?	左上肺下舌段	5	3	?	?
?	左下肺背段	4	2	?	?
?	左下肺前基底段	3	1	?	?

组别	术后6 h	术后12 h	术后18 h	术后24 h	术后36 h	术后48 h
试验组(N＝41)	0.61±0.67	0.39±0.49	0.68±0.47	0.78±0.57	0.78±0.42	0.59±0.50
对照组(N＝41)	2.27±0.92	2.27±0.63	1.78±0.42	1.39±0.54	0.83±0.59	0.78±0.42
t值	9.332	14.972	11.146	4.960	0.433	1.918
P值	0.000	0.000	0.000	0.000	0.666	0.059

组别	术后6 h	术后12 h	术后18 h	术后24 h	术后36 h	术后48 h
试验组(N＝41)	0.61±0.67	0.39±0.49	0.68±0.47	0.78±0.57	0.78±0.42	0.59±0.50
对照组(N＝41)	2.27±0.92	2.27±0.63	1.78±0.42	1.39±0.54	0.83±0.59	0.78±0.42
t值	9.332	14.972	11.146	4.960	0.433	1.918
P值	0.000	0.000	0.000	0.000	0.666	0.059

组别	术后镇痛泵按压次数		术后吗啡注射次数		术后住院时间(min)
组别	0～24 h	24～48 h	0～24 h	24～48 h	术后住院时间(min)
试验组(N＝41)	6.20±2.87	6.02±2.57	0.17±0.38	0.17±0.38	3.68±1.57
对照组(N＝41)	13.20±4.55	7.27±2.42	0.39±0.49	0.22±0.42	3.56±1.75
t值	8.334	2.225	2.225	0.552	－0.332
P值	0.000	0.027	0.027	0.583	0.741

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