The Efficacy and Safety of Paravertebral Block Combined with Parecoxib During Video-Assisted Thoracic Surgery: A Randomized Controlled Trial

被引:14
作者
Yang, Junling [1 ]
Hao, Zaijun [1 ]
Li, Wei [1 ]
Duan, Caiping [1 ]
Fan, Xiujuan [1 ]
Xin, Jing [1 ]
Ren, Chunguang [2 ]
机构
[1] Ordos Cent Hosp, Dept Anesthesiol, Ordos, Peoples R China
[2] Liaocheng Peoples Hosp, Dept Anesthesiol, Liaocheng, Shandong, Peoples R China
关键词
paravertebral block; parecoxib; video-assisted thoracic surgery; preemptive analgesia; POSTOPERATIVE PAIN-CONTROL; THORACOSCOPIC SURGERY; NERVE BLOCKADE; DOUBLE-BLIND; ANALGESIA; THORACOTOMY; ROPIVACAINE; ARTHROPLASTY; CATHETER;
D O I
10.2147/JPR.S244787
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: Although video-assisted thoracoscopic surgery (VATS) is increasingly used, the optimal analgesia strategy is still unknown. We explore the efficacy and safety of preemptive ultrasound-guided paravertebral block (PVB) combined with parecoxib during VATS. Methods: Seventy-four patients were divided into two groups. PVBs were performed before anesthesia induction under real-time ultrasound guidance. Visual analog scale (VAS) score with coughing at 48 h after surgery, postoperative sufentanil consumption and level of sedation (LOS) at 1, 4, 8, 12, 24, and 48 h postoperatively, intraoperative hemodynamics, satisfaction scores of patients and surgeons, remedial measures, time to chest tube removed and mobilization, adverse effects and hospital stay length were recorded. We also recorded inflammatory markers, respiratory function and the prevalence of chronic pain after surgery. Results: VAS scores at rest and with coughing during the first 24 h after surgery were significantly lower in the P group (P<0.05). Consumption of sevoflurane, remifentanil, and dexmedetomidine was all significantly reduced in the P group (P<0.05). The consumption of sufentanil within 48 h after surgery, time to first dose and total dose of rescue ketorolac was significantly lower in the P group (P<0.05). The FEV1/FVC ratio was significantly higher in the P group at 1 and 3 d after surgery (P<0.05). Times to chest tube removal and mobilization were significantly shorter in the P group (P<0.05). Compared with the C group, the level of both ACTH and cortisol was significantly reduced in the P group at 1 and 3 d after surgery (P<0.05). Conclusion: PVB combined with parecoxib was associated with better pain relief, decreased sufentanil and ketorolac consumption, less hemodynamic instability, and a lower surgery-related stress response. However, the incidences of chronic pain 3 and 6 months after surgery and the risk of complication except urinary retention were not significantly different between groups.
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收藏
页码:355 / 366
页数:12
相关论文
共 48 条
[1]   Facilitatory effects of perineural dexmedetomidine on neuraxial and peripheral nerve block: a systematic review and meta-analysis [J].
Abdallah, F. W. ;
Brull, R. .
BRITISH JOURNAL OF ANAESTHESIA, 2013, 110 (06) :915-925
[2]   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 [J].
Bendixen, Morten ;
Jorgensen, Ole Dan ;
Kronborg, Christian ;
Andersen, Claus ;
Licht, Peter Bjorn .
LANCET ONCOLOGY, 2016, 17 (06) :836-844
[3]   Role of Parecoxib Sodium in the Multimodal Analgesia after Total Knee Arthroplasty: A Randomized Double-blinded Controlled Trial [J].
Bian, Yan-yan ;
Wang, Long-chao ;
Qian, Wen-wei ;
Lin, Jin ;
Jin, Jin ;
Peng, Hui-ming ;
Weng, Xi-sheng .
ORTHOPAEDIC SURGERY, 2018, 10 (04) :321-327
[4]   Incidence and Risk Factors Associated With Ipsilateral Shoulder Pain After Thoracic Surgery [J].
Bunchungmongkol, Nutchanart ;
Pipanmekaporn, Tanyong ;
Paiboonworachat, Sahattaya ;
Saeteng, Somcharoen ;
Tantraworasin, Apichat .
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2014, 28 (04) :979-982
[5]   A THERMOGRAPHIC STUDY OF PARAVERTEBRAL ANALGESIA [J].
CHEEMA, SPS ;
ILSLEY, D ;
RICHARDSON, J ;
SABANATHAN, S .
ANAESTHESIA, 1995, 50 (02) :118-121
[6]   Effects of serratus anterior plane block for postoperative analgesia after thoracoscopic surgery compared with local anesthetic infiltration: a randomized clinical trial [J].
Chen, Guodong ;
Li, Yufang ;
Zhang, Yixiao ;
Fang, Xiangming .
JOURNAL OF PAIN RESEARCH, 2019, 12 :2411-2417
[7]   The effect of ultrasound-guided intercostal nerve block, single-injection erector spinae plane block and multiple-injection paravertebral block on postoperative analgesia in thoracoscopic surgery: A randomized, double-blinded, clinical trial [J].
Chen, Nan ;
Qiao, Qiong ;
Chen, RongMin ;
Xu, QiaoQiao ;
Zhang, Yi ;
Tian, YuKe .
JOURNAL OF CLINICAL ANESTHESIA, 2020, 59 :106-111
[8]   A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy -: a systematic review and meta-analysis of randomized trials [J].
Davies, RG ;
Myles, PS ;
Graham, JM .
BRITISH JOURNAL OF ANAESTHESIA, 2006, 96 (04) :418-426
[9]   Video-assisted thoracic lobectomy versus stereotactic body radiotherapy for stage I nonsmall cell lung cancer in elderly patients: a propensity matched comparative analysis [J].
Detillon, Deniece D. E. M. A. ;
Aarts, Mieke J. ;
De Jaeger, Katrien ;
Van Eijck, Casper H. J. ;
Veen, Eelco J. .
EUROPEAN RESPIRATORY JOURNAL, 2019, 53 (06)
[10]   A French Nationwide Survey on Anesthesiologist-Perceived Barriers to the Use of Epidural and Paravertebral Block in Thoracic Surgery [J].
Duale, Christian ;
Gayraud, Guillaume ;
Taheri, Hammou ;
Bastien, Olivier ;
Schoeffler, Pierre .
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, 2015, 29 (04) :942-949