| OBJECTIVE:To explore the optimization of analgesia after thoracoscopic surgery.METHODS:Ninety patients who underwent selective single lobectomy under single thoracoscope from June 2017 to June 2018 in the Department of Thoracic Surgery,Cancer Hospital Affiliated to Kunming Medical University were selected.They were randomly divided into three groups:intravenous controlled analgesia group(hereinafter referred to as intravenous group),single intercostal nerve block group(hereinafter referred to as intercostal group)and single intercostal nerve block+intravenous controlled analgesia+thoracic drainage tube local anesthesia(hereinafter referred to as combined group),each group of 30 patients.All patients in the three groups were treated with single-hole thoracoscopic surgery,combined intravenous anesthesia and double-lumen bronchial intubation.Intercostal nerve block was performed in the intercostal group before closing the chest,at each opening and under the incision,using 0.45%ropivacaine 10 ml in each intercostal space;the same treatment was done in the intravenous group,and the intravenous self-controlled analgesia pump was given;the same treatment was done in the combined group,0.45%ropivacaine 10 ml local anesthesia was given in the area near the thoracic drainage tube,and intravenous self-controlled analgesia was given.Pump.The NRS scores of 3,6,12,24,24 and 48 hours after operation were recorded;the pressing times of the analgesic pump after operation were recorded;when the NRS score was greater than three points,the remedial analgesia was given and morphine injection was given:and the time for each patient to give the remedial analgesic for the first time and the total dose of morphine injection within 48 hours after operation were recorded.The mean arterial pressure(MAP)and heart rate(HR)were recorded at 3,6,12,24 and 48 hours after operation.Nausea and vomiting were recorded within 24 hours after operation,the days of extubation of drainage tube and total drainage volume were recorded,and low SpO 2 and difficulty in expectoration were recorded,and sputum aspiration assisted by fiberoptic bronchoscope was required.RESULTS:1.1 General data and intraoperative dataThere was no statistical difference in general data(age,weight,height,ASA classification)among the three groups.(P>0.05)2.1 Numeric rating scalesAt 3 hours after operation,the NRS score of the combined group was significantly different from that of the intercostal group and the venous group(P<0.05);there was no significant difference between the intercostal group and the venous group(P>0.05);at 6 and 12 hours after operation,the NRS score of the intercostal group was significantly different from that of the venous group and the combined group(P<0.05);there was no significant difference between the venous group and the combined group(P<0.05).>At 24h and 48h after operation,the NRS scores of intercostal group were significantly different from those of venous group and combined group(P<0.05).There was no significant difference in NRS scores between venous group and combined group(P>0.05).2.2 The time of first remedial analgesic after surgeryCompared with intercostal group,the first time of morphine administration in venous group and combined group was significantly longer,especially in combined group(P<0.05).Compared with the intravenous group,the first time of morphine administration in the combined group was longer,but there was no significant difference(P>0.05).2.3 Total amount of remedial analgesics given after surgeryCompared with intercostal group,the consumption of remedial analgesics in intravenous group and combined group decreased significantly(P<0.05),and there was no significant difference in consumption of analgesics between intravenous group and combined group(P>0.05).The consumption of remedial analgesics in intercostal group increased significantly(P<0.05).3.1 Pressing times of analgesic pump after operationWithin 3 hours after operation,there was no significant difference in the number of pressing analgesic pumps among the three groups(P>0.05);the number of pressing analgesic pumps in intercostal group increased significantly(P<0.05)at 3-6 hours,6-12 hours and 12-24 hours after operation;there was no significant difference in the number of pressing analgesic pumps between intravenous group and combined group(P>0.05);and there was no significant difference in the number of pressing analgesic pumps between the three groups at 24-48 hours after(P>0.05).4.1 MAP and HRThere was no significant difference in MAP and HR between the three groups at 3 hours after operation(P>0.05);at 6 hours,12 hours and 24 hours after operation,MAP and HR in venous group and combined group were significantly lower than those in intercostal group(P<0.05);there was no significant difference in MAP and HR between venous group and combined group(P>0.05).At 48 hours after operation,there was no significant difference in MAP and HR among the three groups(P>0.05).5.1 Nausea and vomiting within 24 hours after surgeryWithin 24 hours after operation,the incidence of nausea and vomiting in intercostal group was the lowest,significantly lower than that in the other two groups(P<0.05).There was no significant difference in the incidence of nausea and vomiting between venous group and combined group(P>0.05).6.1 Number of days of extubation of drainage tube and total drainage volume after operationThere was no significant difference in total drainage volume between the three groups(P>0.05);the days of extubation of drainage tube in the three groups were significantly longer in the intercostal group than in the venous group and the combined group(P<0.05);there was no significant difference between the venous group and the combined group(P>0.05).7.1 Postoperative low spo 2,difficulty in expelling sputum and the need for fiberoptic bronchoscope-assisted sputum aspirationAmong the three groups,there were 2 cases of low spo2,difficulty in expectoration and bronchoscopic assisted sputum aspiration in intercostal group,and no cases of low spo2,difficulty in expectoration and need of assisted sputum aspiration in intravenous group and combined group.Conclusion:This study suggests that the use of 0.45%ropivacaine for intercostal nerve block after thoracic surgery is an effective method.The analgesic effect in a short time is good.Compared with the patients who use opioids for systemic intravenous analgesia,it can significantly reduce the incidence of nausea and vomiting after surgery,but effective analgesia can not be maintained for a long time,and single use can not provide satisfactory analgesic treatment.Systemic intravenous analgesia combined with regional block anesthesia has advantages in analgesic effect after thoracoscopic surgery.Compared with single intercostal nerve block,the analgesic effect is more adequate.Compared with single PCIA analgesia,it can provide.equivalent or better analgesic effect,and reduce the dosage of opioids and the incidence of adverse events.Multimodal analgesia with simple and safe regional block anesthesia combined with general intravenous analgesia is an effective and feasible method,which provides ideas for further optimization of post-thoracoscopic analgesia. |
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