| ObjectiveThe purpose of this study is to know the most painful position,the most painful period and the satisfaction with the current analgesia mode after thoracoscopic lung resection.And from the theoretical and practical point of view,it is proved that ice compress is safe and effective.Under the premise of safety and effectiveness,cold therapy is used to relieve postoperative pain of patients undergoing thoracoscopic lung surgery.At the same time,it is explored that cold therapy,as a supplementary treatment of multi-mode analgesia,combined with serratus anterior block technology has additive or synergistic effect,so as to reduce related complications and promote patients’ rapid recovery.Method1.The first stage: 353 patients who underwent video-assisted thoracoscopic pneumonectomy(VATS)in a third-class first-class hospital in Zhenjiang were investigated,and the most painful time and position after operation were found,as well as the patients’ satisfaction with the current analgesia mode.Taking the safety and effectiveness of ice compress as the central problem point,the meta-analysis of database retrieval lines is carried out to determine the safety and effectiveness of ice compress from the theoretical point of view.2.The second stage: the pre-experiment stage.The pre-experiment is divided into three parts.In the first pre-experiment,three different types of liquids(0.9%physiological saline,5% glucose solution and sterilized water for injection)and different doses(200ml and 300ml)were frozen in the freezer to determine which liquid is suitable for ice compress in terms of comfort(keeping smoothie state)and timeliness(keeping smoothie state time);In the second pre-experiment,10 volunteers were subjected to an underarm(near the incision)ice compress experiment with the liquid determined in the first pre-experiment in the frozen slush state,and the skin temperature of the ice compress at different time periods and the sensory experience of the volunteers were recorded.In order to determine the safety and effectiveness of ice compress from the practical point of view;Pre-experiment 3,according to the quantitative questionnaire,the most painful parts and different pain time stages(mild pain time period is set to t1,moderate and severe pain time period is set to t2)of patients after VATS were learned,and they were divided into blank control group C*,ice compress group T1* and ice compress group T2 *;Ice compress combined with serratus anterior block group T3*,10 cases in each group;T1* group was a group that rested for 1 hour every 30 minutes in T1 period,with a total duration of 8 hours;T2*group was a group that rested for 1 hour every 30 min minutes during T2 period,with a total duration of 8 hours.T3* group was treated with(t1+t2)ice compress and serratus anterior block.Collect indicators: the average VAS scores of C*,T1*,t2* and T3*groups in T2 period,and determine the best time period of ice compress and the initial analgesic effect.3.The third stage: the formal experimental stage.120 patients undergoing videoassisted thoracoscopic lung surgery were randomly divided into control group C,ice compress group T1,serratus anterior block group T2 and combined group T3,with 30 patients in each group,and ice compress was performed within the optimal ice compress period obtained in the third experiment.T1 is the group of 30 min ice compress and 1h rest;T2 was serratus anterior block group;T3 was ice compress combined with serratus anterior block group(the time and manner of ice compress were the same as T1 group).The analgesic effect of patients was evaluated by collecting the main indicators: visual analog score(VAS),the secondary indicators: Prince-Henry pain score,postoperative recovery quality scale-15(Qo R-15),24-hour C-reactive protein(CRP)value,white blood cell count(WBC),the use of additional analgesic drugs,and the increase of body temperature within 24 hours after operation.Results1.The first stage(1)Cross-sectional survey results:(1)The periods of mild pain were 0-8h and 16-24 h after operation,and the periods of moderate and severe pain were8-16 h after operation.The VAS score of mild pain was significantly lower than that of moderate and severe pain,with statistical significance(P < 0.05);(2)Postoperative skin incision pain accounted for 23%,pleural irritation pain accounted for 25%,intercostal neuralgia accounted for 52%.(3)79% patients were dissatisfied with the current analgesic mode and analgesic results,8% patients were satisfied,and 13% patients were satisfied.(2)Meta-analysis results:(1)The VAS scores of 425 patients with 7 articles in the ice pack group were significantly lower than those in the control group 24 hours after operation,with statistical significance(P = 0.008);(2)Among the 165 patients who were included in the three literatures,the extra analgesic drugs used by the patients in the ice pack 72 hours after operation were significantly lower than those in the control group,and the difference was statistically significant(P = 0.0009).(3)Among the 165 patients included in 3 literatures,the effect of postoperative pain on cough in the ice pack group was significantly lower than that in the control group,with statistical significance(P = 0.001);(4)No adverse reactions(frostbite,cold allergy,etc.)caused by ice compress were reported in 425 patients in the above 7 documents.2.The second stage Pre-experiment results: Pre-experiment 1: 300 ml of 0.9%physiological saline is put in a 500 ml liquid bag,folded and iced for 2-2.5 hours before use,and the ice bag can be kept in a smoothie state for 30 min in the human temperature range.Pre-experiment 2: All 10 volunteers can reach the temperature of local anesthesia effect and local analgesia effect after 15 minutes of ice compress,and ice compress is safe and effective in volunteer experiments without complications.Pre-experiment 3:(1)The analgesic effect of starting ice compress in mild pain period is obviously better than that in moderate and severe pain period,and the difference is statistically significant(p<0.05).(2)Compared with the control group,the ice pack group and the serratus anterior block group,the combined group had the best analgesic effect,with statistical significance(P < 0.05).3.The third stage Formal experimental results: Main outcome: Compared with the control group,the patients in the serratus anterior block group,the ice pack group and the ice pack combined with serratus anterior block group had significantly reduced pain within 24 hours,and the difference was statistically significant(p<0.05).Other secondary indicators: Compared with the control group,the scores of Prince-Henry pain within 12 hours,Qo R-15 within 24 hours and the number of fever within 24 hours in other groups were better than those in the control group,with statistical significance(P < 0.05);There was no significant difference in CRP,WBC and the use of additional analgesic drugs within 24 hours after operation(p>0.05).ConclusionAfter video-assisted thoracoscopic pneumonectomy,the analgesic effects of ice compress,serratus anterior block and ice compress combined with serratus anterior block are better than those of the control group,and the combined group has the best analgesic effect. |
