The Control Study Of Post-thoracotomy Pain Interference Using Ropivacaine For Intercostal Nerve Block By Continuously Dripping Irrigation

Objective: To observe the effect of post-thoracotomy abirritation after using Ro pivacaine continuously dripping irrigation for intercostal nerve block. Accessing its clinical application and prediction value after analgesia in thoracic surgery.Method: 60 patients underwent thoracic surgery were selected to randomly divid ed into three groups(A, B and C groups), each of the group was contained 20 p atients. Group A was as blank-control, using muscle injection of pethidine hydroch loride to control postoperative pain. Group B used PCIA(Patient Controlled Intrav enous Analgesia) after thoracotomy. Post-thoracotomy patients in Group C were ac complished abirritation in taking Ropivacaine continuously dripping irrigation for i ntercostal nerve block. Checked and recorded the index of group A, B and C in consecutive 7 days after surgery: 1. Used VAS(Visual analogue scale/score) Scores to record the patients general anesthesia score from day 1 to day 7(1-10 scores). When all three groups recovered from anesthesia, pain index observation was star ted. If VAS≥5, pethidine hydrochloride should be injected in muscle for abirritatio n(1mg/kg, 50-100mg/times). Recorded the index twice per day, and the highest in dex was the final data of VAS. 2. Recorded situation of sputum excretion after su rgery(initiative sputum, assisted sputum and passive sputum). 3. Recorded overall volume of pethidine hydrochloride used for three groups. 4. The complications rat e after surgery:(pulmonary atelectasis, hydrothorax, wound infection). 5. Anesthesi a complications rate after surgery:(uroschesis, drowsiness, nausea and vomiting, ra sh).Result: The average VAS scores on first day after surgery: A(7.5)/B(6.0)/C(5.1). Each group was compared with SNK method, and the result was statistically signi ficant(P<0.001). Group C abirritation effect was better than group B and A, but standard deviation was A(1.0)/B(1.1026)/C(1.917), respectively. Group C standard d eviation was the biggest one, which abirritation effect had enormous diversity and was not stable. The second day after surgery, VAS average scores was: A(6.4)/B(4.85)/C(4.25), respectively. Group C and B compared to group A had statistical si gnificance(P<0.001). It was statistically significant that group C abirritation was b etter than group A and B. Compared group A and group B, the P value was 0.139, and there was no statistical significance. The 3rd day to 7th day after surgery, VAS in group A were(3.45, 3.15, 2.3, 2.10 and 2); VAS in group B were(3.20, 2.80, 2.3, 2.05 and 1.8); VAS in group C were(3.1, 2.75, 2.3, 2.05, 1.75); each two groups compared SNK and P values were: 0.298/0.208/1、0.953/0.375, all of the values were >0.05. So the VAS after the 3rd day to 7th day had no statistical significance. 2. Sputum excretion situation: Initiative sputum ratio: group A < gro up B and C(P<0.05) with statistical significance. Group B< group C with statist ical significance for initiative sputum(P<0.05); assisted sputum ratio: each two gr oups compared without statistical significance(P>0.05); passive sputum ratio: gro up A > group B >group C(P<0.05). Group B > group C without statistical sign ificance for passive sputum(P>0.05). Postoperative usage of pethidine hydrochlorid e injection in three groups were: 55 mg(156.75), B(70.55 ±32 mg), and C(50.41 ± 60mg), respectively. Comparison of A, B and C groups had statistical signi ficance(P < 0.05). 4. Postoperative complications:The incidence of atelectasis we re: A(20%)/B(10%)/C(5%), each two groups compared without statistical signifi cance. The incidence of hydrothorax: A(25%)/B(15%)/C(10%), group A > grou p B and C, group B> group C, each two groups compared without statistical sign ificance. The incidence of wound infection: no statistical significant difference amo ng group A, B and C, only group A had one patient got the infection. 5. Anesth esia complication: Group A > group B and C, there was no statistically significan ce.Conclusion: Application of Ropivacaine to continuously dripping irrigation for i ntercostal nerve block on post-thoracotomy patients can be an ideal abirritation me thod. When thoracic surgical incision < 20 cm and patients without no rib injury and less trauma, Ropivacaine continuously dripping irrigation for intercostal nerve block can show more stable abirritation. This method might be the relative indicat ions of the analgesic way.