The Clinical Study On Analgesic Effect Of Patient-controlled Epidural And Intravenous Analgesia In Chronic Pain After Thoracic Surgery

Objective:To explore the effect of Analgesic patient-controlled epidural and intravenous analgesia in chronic pain after thoracic surgery Methods:Two hundred and forty patients,Age(?18 years old),ASAI ~ II grade,preoperative examination without contraindication of epidural anesthesia,liver and kidney function indicators were in the normal range who underwent elective thoracic surgery.They were divided into three groups: SI,PCIA after thoracoscopic surgery;SE,PCEA after thoracoscopic surgery;TE,PCEA after thoracotomy.The prescription of PCIA group: sufentanil 150 ug,oxycodone 40 mg,normal saline diluted to 150 ml.PCEA group: ropivacaine 300 mg,fentanyl 0.5 mg,saline dilution to 300 ml.The induction drugs for general anesthesia are the same.The analgesic effect was recorded 24 hours and 48 hours after operation,and the degree of pain was evaluated by visual analogue scale(VAS score).The common adverse reactions of nausea,vomiting and pruritus during analgesia were recorded.Telephone follow-up was used in 2 months,3 months and 6 months after operation to investigate whether the patient has chronic pain and the corresponding numbness of intercostal nerve innervation area.Resules:VAS scores in SE group at 24 h and 48 h after operation were lower than those in SI group and TE group(P < 0.05).The incidence of adverse reactions in SE group was lower than that in SI group(P < 0.05).There was no significant difference in the incidence and degree of chronic pain between the three groups(P > 0.05).The incidence of numbness in TE group was the highest(65.8%),followed by SE group(64.6%)and SI group(55.8%)and there was no statistical difference among the three groups(P > 0.05).The incidence of chronic pain in patients with VAS score > 3 at 24 hours after operation was higher than that in patients with VAS score ? 3 at 2 months after operation,and the difference between groups was statistically significant(P <0.05).Conclusion:PCEA is superior to PCIA in controlling acute pain in thoracic surgery,but has no effect on chronic pain.Compared with thoracotomy,thoracoscopic surgery can alleviate acute pain after operation,but has no obvious effect on long-term chronic pain.The VAS score of 24 hours after thoracic surgery > 3 increased the incidence of chronic pain 2 months after surgery.