| Objective:The purpose of this study, by comparing the analgesic effects in three groups, was to explore the perspective of intercostal nerve blockade with Kezepu (Compound menthol lidocaine hydrochloride injection) after thoracotomy in perioperative period in clinical application.Methods: According this study's standard, we have totally got 180 patients who had undergone post-lateral chest operation from February 2006 to December 2007. And those patients were randomly divided into intercostal nerve blockade group (group A), intercostal nerve freezing group (group B) and patient controlled intravenous analgesia (PCIA) group (group C) with 60 patients in each group. The postoperative incision pains was recorded by the visual analogue scales (VAS) at immediate awake time, the 4th hour , the 8th hour, the 12th hour, the 24th hour, and the same time every day until the 10th day, at every monitoring point above the tested patient was requested to cough and breathe deeply,then the analgesic effective rate in the three groups could be worked out. The pulmonary function measured by maximal vital volume and forced expiratory volume in one second (MVV and FEV1)was conducted at the third day, the 7th day, the 14th day and the 21st day postoperatively. To compare heart rate, breath frequency and finger-tip's oxygen saturation perioperative and postoperative around 24 hours. In addition, the comparison among the time spend by analgesic operation, the dosage of analgesic (dolantin) and incidence rate of pulmonary complications in every group also need to be done. The SPSS10.0 and SAS8.01(only for Fisher's exact test)was used to perform the analysis.Results:1 The scores of VAS:â‘ Statistic analysis showed that the scores of VAS were significantly different at every monitoring point among three groups (P<0.05). Further analysis revealed that the scores in both group A and group B were higher than that of group C(P<0.05), however, group A and group B can be seen no difference in statistics(P>0.05).â‘¡Statistic analysis showed that the analgesic effective rate was significantly different at every monitoring point among three groups (P<0.05). Further analysis revealed that the analgesic effective rate in both group A and group B were higher than that of group C(P<0.0125), however, group A and group B can be treated as no difference in statistics(P>0.0125).2 The average dosage of dolantin:there were significant differences among the three groups on mean dosage of dolantin (P<0.05). Further analysis showed that the average dosage of dolantin in both group A and group B were higher than that of group C(P<0.05), however, group A and group B can be seen no difference in statistics(P>0.05).3 The incidence rate of pulmonary complications: In group A, atelectasis was observed in 1 patients (1.67%), pulmonary infection in 1 (1.67%), however, none of patient suffer from respiratory depression, pleural effusion, hypotension, dizziness and lethargy. In group B, atelectasis was observed in 2 patients (3.33%), pulmonary infection in 1(1.67%), and none of patient suffer from respiratory depression, pleural effusion, hypotension, dizziness and lethargy. In group C, atelectasis was observed in 8 patients (13.33%), pulmonary infection in 7 (11.67%), respiratory depression in 2 (3.33%), pleural effusion in 3 (5.00%), hypotension in 3 (5.00%), dizziness and lethargy in 5 (8.33%). In every group, the total rate of pulmonary complications was observed in 1 patient (1.67%), 2 patients (3.33%), and 10 patients (16.67%) respectively. The result had a significant difference among the three groups in statistic analysis (P<0.05). Further analysis showed that the incidence rates of pulmonary complications in group A and group B were lower than that of group C(P<0.0125), but there was no significant difference between group A and group B(P>0.0125). 4 The obedience of coughing and expectorating: when asked to cough and expectorate, patients in group A and group B apparently have less pain than group C, but there was no significant difference between group A and group B.5 The consuming time on analgesic operation: statistic analysis showed that the consuming hours of operation was significantly different among the three groups (P<0.05). And further analysis pointed that the time spend by analgesic operation in group B was longer than that of both group A and group C (P<0.05), and the duration of analgesic operation in group A was longer than that of group C (P<0.05).6 The variance in heart rate, breath frequency and finger-tip's oxygen saturation before and after operation within 24 hours: these indexes of these three groups had significant difference respectively (P<0.05). Whether group A or group B was compared with group C, P<0.05, however, when group A was compared with group B, P >0.05.7 The recovery of lung function: the pulmonary function improves more quickly in group A and group B than that of group C, and during the same time there was no significant difference between group A and group B. But from the 14th day to the 21st day there were no significant difference among the three groups.8 The duration of numbness in operation location: there were significant differences among the three groups on duration of numbness(P<0.05). Further analysis showed that no difference was observed between group A and group C (P >0.05), and when group A or group C was compared with group B there was significant difference (P<0.05).Conclusions:1 Comparing between group A, group B and group C: the scores of VAS at every monitoring point and the rates of analgesic effects in group A and group B was more great than that of group C. The former two groups did better in coughing or expectorating, and had more quickly pulmonary function recovery and less complication.2 Comparing between group A and group B, group C: there were much simpler in operation and more perfectible effects in analgesia than that of group A and group B. To prevent intense chest pain after thoracotomy, the intercostal nerve blocking with Kezepu (group A) could be seen as ideal analgesic method. In addition, the consume cost in group A was much lower than both group B and group C.3 Comparing between group A and group B: the analgesic effect was nearly equal, but the analgesic operative time in group A was shorter than that of group B, and in group A the anesthetic feeling fade away more faster, which benefits for patient recovery.4 The approach of intercostal nerve blocking with Kezepu would be the best combining point of the ideal analgesic effects and the easy to operate and the minimal cost. It is important to provide theoretical and practical basis for further application of alleviating and preventing post-thoracotomy severe chest pain.
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