Clinical Controlled Trial Of Multi-Modal Analgesia After Thoracoscopic Surgery

Objective Due to the minimally invasive advantages of Video-assisted thoracoscopic surgery(VATS),postoperative pain is reduced compared with conventional thoracotomy,but there is still a certain degree of injury and postoperative pain.Postoperative pain can lead to an increase in the incidence of postoperative complications,which is not conducive to postoperative rehabilitation,resulting in prolonged hospital stay.In order to promote postoperative rehabilitation of patients,patients with VATS surgery were enrolled in the study,and a clinical controlled trial of postoperative analgesia after VATS was performed to provide reference for postoperative analgesia after VATS.Methods A total of 164 VATS patients admitted to thoracic surgery of General Hospital of Ningxia Medical University from March 2018 to December 2018 were enrolled,including 44 in group A,60 in group B and 60 in group C.All patients enrolled were treated with Patient-controlled Intravenous Analgesia(PCIA)and Inter-costal Nerve Block(ICNB)as the basic analgesia.Preoperative and postoperative addition of parecoxib sodium to assist analgesia was recorded as group A;postoperative addition of parecoxib sodium to assist analgesia was recorded as group B;group C did not use parecoxib sodium.The operation name,operation time(h),intraoperative blood loss(ml),visual analogue scale(VAS),three groups of PCIA drug use time(h),and adverse reactions of anesthetic analgesics were recorded.The incidence of dizziness,nausea,vomiting,itchy skin,postoperative pulmonary complications(pulmonary infection,atelectasis),the addition of analgesic drugs within 72 hours in three groups,chest drainage time(h)and the postoperative hospitalization time(d)in three Group for statistical analysis.The measurement data were analyzed by one-way ANOVA,and the counting data were tested by Chi-square test.Results 1.There was no significant difference in gender,age and body mass index(BMI)among group A,group B and group C under the same surgical procedure(Thoracoscopic pulmonary lobectomy,Thoracoscopic pulmonary wedge resection)(P>0.05).2.There was no significant difference in the operation time and intraoperative blood loss between the three groups under the same surgical procedure(P>0.05).3.There was no significant difference in chest drainage time between the three groups under the same surgical procedure(P>0.05).4.Comparison of drug use time of PCIA in three groups under the same surgical procedure.There was no difference between group A and group B(P>0.05)in drug use time of PCIA,The time of drug use of PCIA in group A and B was longer than that in group C(P<0.05),that is,the times of pressing anesthesia analgesia pumps in group A and B were less than that in group C.5.There was no difference between group A and group B in the same surgical procedure(P>0.05),The postoperative hospitalization time of group A and group B was shorter than that of group C(P<0.05).6.Comparing the three groups of patients with the same surgical procedure,Compared with group B and group C,group A had less pain in resting state and cough state at each time after operation(P<0.05).There was no significant difference in resting VAS score and cough VAS score between group B and group C at 6 hours after operation(P>0.05),the pain degree of group B was less than that of group C at other time points after operation(P<0.05).7.The incidence of postoperative pulmonary complications in the three groups was lower than that in the C group(P<0.0125).There was no difference between the A and B groups(P>0.0125).8.The rate of additional analgesic drugs in the three groups was statistically significant(P<0.0125).The rate of postoperative analgesic drugs in group A and group B was significantly lower than that in group C.The rate of additional analgesic drugs in group A was lower than that in group B.9.The incidence of adverse reactions of postoperative anesthesia and analgesic drugs in the three groups were statistically significant(P<0.0125).The incidence of adverse reactions of postoperative anesthesia and analgesic drugs in group A and group B was significantly lower than that in group C.The incidence of adverse reactions of anesthetic analgesic drugs in group A was lower than that in group B.Conclusion PCIA combined with ICNB as the basic analgesia,combined with preoperative and postoperative use of parecoxib sodium significantly reduced perioperative pain and reduced postoperative pulmonary complications and anesthetic analgesic adverse drug reactions It shortens the length of hospital stay,which is conducive to postoperative rehabilitation.It is worthy of reference for postoperative analgesia after VATS.