The Application Of Local Cryotherapy Combined With Intercostal Nerve Block And Patient Controlled Intravenous Analgesia In Video-assisted Thoracoscopic Surgery

Objective:To compare the analgesic effects of the three groups of patients with simple patient-controlled intravenous analgesia,intercostal nerve block and local cold therapy combined with intercostal nerve block and patient-controlled intravenous analgesia,and to explore the appropriate analgesic mode after thoracoscopic operation.Methods:We selected 60 patients who underwent three-hole thoracoscopic surgery in our department from May 2016 to May 2017.They were randomly divided into three groups: intravenous analgesia group,intercostal nerve block combined with intravenous analgesia group,local cryotherapy combined with intercostal nerve block and intravenous analgesia group(20 cases in each group).All the three groups were treated with three-hole thoracoscopic surgery,all were given general anesthesia,double-lumen tracheal intubation and postoperative intravenous analgesia pump.In the intercostal group,0.75 ropivacaine was injected into the each incision intercostal,superior intercostal and lower intercostal before the closed chest.Each intercostal was treated with 3ml.The cold therapy group and intercostal group were treated with the same treatment,and the incision local intermittent cold therapy was given within 24 hours after operation.The visual analogue scale score,Prince-Henry score,postoperative analgesia pump self-control times,tramadol frequency,total drainage flow,extubation days and complications were observed in three groups of patients at 3 hours,6 hours,12 hours,24 hours,48 hours after operation.SPSS 17 software was used for statistical analysis.The measurement data were expressed as mean±standard deviation,the analysis of variance was used in the comparison between groups,and the counting data was measured by the second test,P < 0.05 showed statistical significance.Results : 1.Pain score Compared with intravenous group,visual analogue scale scores in intercostal group and cryotherapy group were significantly lower than those in intravenous group at 6 hours,12 hours,24 hours and 48 hours.(P < 0.05);Cryotherapy group visual analog scale scores were significantly lower than that of intercostal group in the intercostal after 6 hours,12 hours,24 hours.(P < 0.05).The Prince-Henry score in the intercostal group was significantly lower than that in the venous group at 3 hours after the operation;Compared with intravenous group and intercostal group,the Prince-Henry score of cryotherapy group was decreased significantly at 6 hours and 12 hours after operation;Compared with the intravenous group,the Prince-Henry score of intercostal group and cryotherapy group was decreased significantly at 12 h,24h,48 h.2.Press times of analgesic pump and the frequency of intramuscular injection of tramadol Compared with the venous group,intercostal group and cryotherapy group significantly reduced the number of press times of analgesic pump at 3 to 6 hours,6 to 12 hours,12 to 24 hours(P < 0.05);Compared with the intercostal group,cryotherapy group significantly reduced the number of press times of analgesic pump at 3 to 6 hours,6 to 12 hours,12 to 24 hours(P < 0.05).Compared with the intravenous group,cryotherapy group and intercostal group significantly reduced the number of the frequency of intramuscular injection of tramadol at 6 to 12 hours,12 to 24 hours(P < 0.05).3.Total drainage volume and days of extubation There was no statistical difference among the three groups in the comparison of total drainage volume.However,the days of extubation in the cryotherapy group and intercostal group were all earlier than those in the venous group(P < 0.05).4.postoperative complications Among the three groups of patients: In the venous group,there were 2 cases of somnolence,1 cases of nausea and vomiting,6 cases of atelectasis after operation,1 cases of wound infection and delayed disassembly,and 6 cases of postoperative chronic pain.In the intercostal group,there were 1 cases of somnolence,3 cases of atelectasis after operation,and 5 cases of chronic pain after operation.In the cryotherapy group,3 cases of postoperative somnolence occurred,2 cases of atelectasis,3 cases of postoperative patients with chronic pain;In the intercostal group and cryotherapy group,there were no postoperative nausea and vomiting,wound infection,delayed disassembly and other complications.There was no significant difference in complications among the three groups.Conclusion:Local cryotherapy combined with intercostal nerve block and intravenous analgesia can provide adequate and effective postoperative analgesia for video-assisted thoracoscopic surgery patients,improve patient satisfaction with analgesia.