肋间神经保护对剖胸术后疼痛改善的随机前瞻研究

目的 通过保护后外侧剖胸切口双侧肋间神经,评估患者术后近期疼痛改善的幅度,并了解不同程度的保护对术后疼痛的改进作用.方法 自2006年10月10 日至2007年4月10日满足入选标准的患者共60例,均采用后外侧剖胸切口入胸.按照前瞻性单盲随机对照研究要求,将患者随机分为传统后外侧切口组(对照组,18例)、单侧肋间神经保护组(单侧组,20例)、双侧肋间神经保护组(双侧组,22例)3组.疼痛分级采用数字疼痛强度分级法.记录患者术后不同时间点疼痛评分及镇痛药物的用量.结果 双侧组术后2～7 d及术后1个月切口疼痛均明显轻于对照组(P＜0.05).单侧组术后2、3、5、7 d切口疼痛明显轻于对照组(均P＜0.05).双侧组胸管拔除后1 d较拔管前疼痛有明显缓解(P=0.020),单侧组及对照组疼痛缓解不明显(P值分别为0.091,0.768).3组患者并发症发生率差异无统计学意义.结论 与传统手术相比,保护切口双侧肋间神经可以明显减轻术后急性疼痛程度,尤以术后1个月时疼痛缓解最为明显.这种方法并不增加并发症发生率.

Effect of bilateral intercostal nerve protection on post-thoracotomy pain relief: a prospective single-blinded randomized study

OBJECTIVE: To study the efficacy of bilateral intercostal nerve protection on pain relief after thoracotomy. METHODS: Sixty patients in need of thoracotomy were randomized into 3 groups: Group C (control group, undergoing standard posterolateral thoracotomy, n = 18), Group U (unilateral intercostal nerve protection group, undergoing protection of intercostal nerve above the incision based on the standard posterolateral thoracotomy, n = 20), and Group B (bilateral intercostal nerve protection group, undergoing protection of intercostal nerves above and below the incision based on the standard posterolateral thoracotomy, n = 22). Numeric rating scale (NRS) was adopted to document the severity of pain at different time points after surgery. The amount of analgesic use was recorded as well. RESULTS: The pain scores recorded on the postoperative days 2 to 7 and 1 month after surgery of Group B were all significantly lower than those of Group C (all P < 0.05). Significant pain relief was observed in Group U within the 7 postoperative days compared with Group C; however, there were not significant differences in pain scores among different groups 1 month after surgery. Pain relief after the removal of chest tubes was found only in Group B (P = 0.020). The incidence of morbidity was similar among the 3 groups. CONCLUSION: Protection of bilateral intercostal nerves around the incision contributes to significant pain relief after operation without increase of the morbidity of complications.