文章摘要
胸椎旁联合肋间神经阻滞对胸腔镜手术女性患者术后反弹性疼痛的影响
Effect of thoracic paravertebral nerve block combined with intercostal nerve block on postoperative rebound pain in female patients undergoing thoracoscopic surgery
  
DOI：10.12089/jca.2025.08.004
中文关键词: 视频辅助胸腔镜手术  反弹性疼痛  女性  胸椎神经阻滞  肋间神经阻滞
英文关键词: Video-assisted thoracoscopic surgery  Rebound pain  Female  Paravertebral nerve block  Intercostal nerve block
基金项目:
作者单位E-mail
徐亚杰 210006,南京医科大学附属南京医院 南京市第一医院麻醉疼痛与围术期医学科  
夏道林 南京医科大学康达学院附属盱眙人民医院麻醉科  
方兆晶 210006,南京医科大学附属南京医院,南京市第一医院麻醉疼痛与围术期医学科  
张文文 210006,南京医科大学附属南京医院,南京市第一医院麻醉疼痛与围术期医学科  
张勇 210006,南京医科大学附属南京医院,南京市第一医院麻醉疼痛与围术期医学科  
朱丽丽 210006,南京医科大学附属南京医院,南京市第一医院麻醉疼痛与围术期医学科  
许汝坤 210006,南京医科大学附属南京医院,南京市第一医院麻醉疼痛与围术期医学科  
李子萱 210006,南京医科大学附属南京医院,南京市第一医院麻醉疼痛与围术期医学科  
姜雪 210006,南京医科大学附属南京医院,南京市第一医院麻醉疼痛与围术期医学科  
刘慈宝 210006,南京医科大学附属南京医院,南京市第一医院麻醉疼痛与围术期医学科  
王晓亮 210006,南京医科大学附属南京医院,南京市第一医院麻醉疼痛与围术期医学科 wxl145381@njmu.edu.cn 
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中文摘要:
      
目的： 探讨胸椎旁联合肋间神经阻滞对女性患者行双孔视频辅助胸腔镜手术（VATS）术后反弹性疼痛的影响。
方法：选择2023年12月至2024年8月择期行双孔VATS的女性患者150例，年龄18～44岁，BMI 18.5～28.0 kg/m2,ASA Ⅰ或Ⅱ级。采用随机排列区组随机化法将患者分为两组：胸椎旁神经阻滞组（T组）与胸椎旁联合肋间神经阻滞组（L组），每组75例。两组患者于术前30 min接受术侧T4及T6节段超声引导下胸椎旁神经阻滞，每位点注射0.375%罗哌卡因20 ml。L组在手术医师完成胸腔内操作前在两切口对应肋间于胸腔镜直视下分别注射0.375%罗哌卡因各10 ml。主要指标：术后24 h内反弹性疼痛的发生情况（反弹性疼痛定义为手术部位的剧烈疼痛，NRS评分≥7分）。次要指标：术后6、12、24、36、48及72 h NRS疼痛评分、术后72 h内羟考酮用量、镇痛泵总按压次数、有效按压次数、首次按压时间、住院时间、术后不良反应和40项恢复质量评分量表（QoR-40）评分。
结果：与T组比较，L组术后反弹性疼痛发生率明显降低，术后24及36 h NRS疼痛评分明显降低（P＜0.05），术后72 h内羟考酮用量、镇痛泵总按压次数及有效按压次数明显减少，首次按压时间明显延长，QoR-40评分明显升高（P＜0.05）。两组术后住院时间和不良反应发生率差异无统计学意义。
结论：与单纯应用胸椎旁神经阻滞比较，采用胸椎旁联合肋间神经阻滞可降低年轻女性患者双孔VATS术后反弹性疼痛的发生，减少术后镇痛药消耗量，提高术后QoR-40评分。
英文摘要:
      
Objective: To investigate the effect of thoracic paravertebral block combined with intercostal nerve block on postoperative rebound pain in female patients undergoing two-port video-assisted thoracoscopic surgery (VATS).
Methods: A total of 150 female patients, aged 18 to 44 years, BMI 18.5-28.0 kg/m2, ASA physical status Ⅰ or Ⅱ, who were scheduled for two-port VATS from December 2023 to August 2024, were randomly allocated into two groups using a blocked randomization method: the thoracic paravertebral nerve block group (group T) and the thoracic paravertebral combined with intercostal nerve block group (group L), 75 patients in each group. Both groups received ultrasound-guided thoracic paravertebral nerve block at T4 and T6 segments on the surgical side 30 minutes before the operation, with 20 ml of 0.375% ropivacaine injected at each site. In group L, each 10 ml of 0.375% ropivacaine was additionally administered under thoracoscopy at the corresponding intercostal spaces of the two incisions prior to the completion of the intra-thoracic procedure by the surgeon. The primary outcome was the incidence of rebound pain within 24 hours postoperatively (rebound pain was defined as severe pain at the surgical site with a NRS score ≥ 7). Secondary outcomes included NRS pain scores at 6, 12, 24, 36, 48, and 72 hours postoperatively, the dosage of oxycodone within 72 hours after surgery, the time of the first press of the analgesic pump, the actual number of presses and the effective number of presses, the length of hospital stay, postoperative adverse reactions and the score of the 40-item quality of recovery (QoR-40) scale.
Results: Compared with group T, group L exhibited a significantly lower incidence of rebound pain and significantly lower NRS pain scores at 24 and 36 hours postoperatively (P < 0.05), and group L demonstrated significantly reduced oxycodone usage, actual press times, and effective press times within 72 hours postoperatively, a significantly delayed first press time, and significantly higher QoR-40 scores (P < 0.05). There were no statistically significant differences in postoperative hospital stay and incidence of adverse reactions between the two groups.
Conclusion: Compared with the use of thoracic paravertebral nerve block alone, the application of thoracic paravertebral block combined with intercostal nerve block can effectively reduce the incidence of rebound pain after two-port VATS in young female patients, reduce postoperative analgesic drug consumption, and improve postoperative QoR-40 scores.
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