Continuous right thoracic paravertebral block following bolus initiation reduced postoperative pain after right-lobe hepatectomy: a randomized, double-blind, placebo-controlled trial.
Continuous right thoracic paravertebral block following bolus initiation reduced postoperative pain after right-lobe hepatectomy: a randomized, double-blind, placebo-controlled trial.
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DOI：
10.1097/aap.0000000000000167
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发表时间：
2014-11
影响因子：
5.1
通讯作者：
Tian Y
中科院分区：
文献类型：
--
作者：
Chen H;Liao Z;Fang Y;Niu B;Chen A;Cao F;Mei W;Tian Y
我们假设，持续右胸椎旁阻滞，推注开始后，右叶肝切除术后接受舒芬太尼静脉自控镇痛的患者阿片类药物的消耗减少。接受右叶肝切除术的患者在手术前30分钟在T7放置右胸椎旁导管，随机分配通过该导管接受10 mL 0.2%罗哌卡因推注，然后以6 mL/h的速度持续输注24小时（PVB组），或相同给药方案的生理盐水（对照组）。所有患者在麻醉后监护室开始使用舒芬太尼进行患者自控静脉镇痛。主要结果指标是术后24小时内舒芬太尼的总消耗量。P = 0.05被认为是显著的。对于5个不同时间点数据的多重比较，将0.05显著性水平的P值调整为0.01。66例患者接受了合格性评估，48例患者成功置入PVB导管。分析PVB组22例患者和对照组22例患者的数据。术后24 h，PVB组舒芬太尼累积用量（54.3 ± 12.1 μg）较对照组（68.1 ± 9.9 μg）减少20%以上（P < 0.001）。两组之间的疼痛评分（数字评定量表）也有显著差异，其中PVB组在休息和咳嗽的前24小时的评分低于对照组（P < 0.001）。持续右胸椎旁阻滞，推注开始后，对右叶肝切除术患者舒芬太尼患者自控静脉镇痛有阿片类药物节省作用，并减少术后前24小时休息时和咳嗽时的疼痛评分。
We hypothesized that continuous right thoracic paravertebral block, following bolus initiation, decreases opioid consumption after right-lobe hepatectomy in patients receiving patient-controlled intravenous analgesia with sufentanil. Patients undergoing right-lobe hepatectomy with a right thoracic paravertebral catheter placed at T7 30 minutes before surgery were randomly assigned to receive through this catheter either a 10-mL bolus of 0.2% ropivacaine before emergence, followed by a continuous infusion of 6 mL/h for 24 hours (PVB group), or saline at the same scheme of administration (control group). All patients were started on patient-controlled intravenous analgesia with sufentanil in the postanesthesia care unit. The primary outcome measure was total sufentanil consumption during the first 24 postoperative hours. P = 0.05 was considered as significant. For the multiple comparisons of data at 5 different time points, the P value for the 0.05 level of significance was adjusted to 0.01. Sixty-six patients were assessed for eligibility, and a PVB catheter was successfully placed for 48 patients. Data were analyzed on 22 patients in group PVB and 22 patients in the control group. The cumulative sufentanil consumption in the PVB group (54.3 ± 12.1 μg) at 24 postoperative hours was more than 20% less than that of the control group (68.1 ± 9.9 μg) (P < 0.001). There was also a significant difference in pain scores (numerical rating scale) between groups, where the PVB group had lower scores than did the control group at rest and with coughing for the first 24 hours (P < 0.001). Continuous right thoracic paravertebral block, following bolus initiation, has an opioid-sparing effect on sufentanil patient-controlled intravenous analgesia for right-lobe hepatectomy patients and reduces numerical rating scale pain scores at rest and with coughing in the first 24 postoperative hours.