Clinical Study Of Pain Control With Continuous Intercostal Nerve Block After Thoracotomy

Background:Thoracic surgery is a common therapy for thoracic diseases,such as mediastinum,lung and esophagus.However,thoracic surgery is often accompanied by postoperative chest incision pain.Postoperative pain can not only cause a stress response,but also affect the patient’s breathing,coughing,and sputum production,leading to obstruction of the patient’s airway secretions,and ultimately leading to complications such as pneumonia and atelectasis.Therefore,good analgesia after thoracotomy not only helps to improve the quality of life of patients,but also helps to reduce postoperative complications,which has important clinical significance.Epidural analgesia is a common method of regional analgesia after thoracotomy.The analgesic effect is good,but it can easily lead to complications such as nausea and vomiting,respiratory depression,urinary retention,and hypotension.Intercostal nerve block analgesia locally injects anesthetics into the intercostal nerve groove to block the intercostal nerve.It has the characteristics of simple and safe operation and fewer complications.However,the analgesic duration of single intercostal nerve block is short and analgesic effect is poor.Continuous intercostal nerve block analgesia through chest wall catheterization after thoracotomy is an important method to further improve the analgesic effect of intercostal nerve block.Objective: This study aims to compare the effect of continuous intercostal nerve block with single intercostal nerve block and epidural analgesia in postoperative analgesia in patients who underwent thoracotomy.Thus providing reference basis for clinical application of continuous intercostal nerve block for analgesia after thoracotomy.Methods: 120 patients who underwent thoracotomy in the Department of Thoracic Surgery in our hospital from November 2017 to October 2018 were enrolled,including 60 males and 60 females,aged 40-77(58.10±7.00)years.The random number table was used to generate a random sequence and the patients were randomly divided into groups A,B and C,with 40 cases in each group.Group A is the continuous intercostal nerve block group,and the postoperative analgesia program is to continuously pump 0.075% ropivacaine(3m L/h)through the puncture device to continuously block the intercostal nerve;group B is the single intercostal nerve block group,the postoperative analgesia program was 0.25% ropivacaine single injection(3m L)for intercostal nerve block;group C was the epidural analgesia group,and the postoperative analgesia program was passing the routine preoperative tube to continuously pump 0.2% ropivacaine(4-8 m L/h)for epidural analgesia.The three groups of patients all received basic analgesia program + local analgesia program,of which the basic analgesia program was parecoxib sodium(40 mg q12 h iv)+pethidine(1.5 mg/kg q8 h im),and the main complaint was when the patient complained of pain.Supplemental injection of pethidine was given to salvage analgesia when the pain occurred.From 6 hours to the 4th day after operation,the patients were scored with the visual analog pain score(VAS)pain scale combined with the digital score scale.At the same time,the daily supplementary pethidine dosage and postoperative hospital stay of each group of patients were recorded.The postoperative pain scores and the additional analgesic doses of the patients in each group were compared,and the clinical application effects of the three analgesic programs were evaluated.Results: On the 0th day after surgery,the all three local analgesic programs combined with basic analgesia can effectively control pain,and the visual analog pain scores of the three groups of patients were not significantly different(P>0.05).The visual analog pain scores of the three groups were group A(2.02± 0.39)points,group B(2.13±0.75)points,and group C(2.03±0.69)points,respectively.There was no significant difference in pain scores between group A and group C on the 0-2d and 3-4d after the operation [(2.08±0.28)points vs.(1.93±0.53)points,(3.20±0.53)points vs.(3.46±0.47)points,P>0.05].However,the pain scores of the patients in each group were significantly higher in 3-4 days than the 0-2 days after the operation,and the difference was statistically significant [(group A,(3.20±0.53)points vs.(2.08±0.28)points;group B,(3.95±1.07)points vs.(2.42±0.73)points;group C,(3.46±0.47)points vs.(1.93±0.53)points,P<0.05].The additional analgesic doses of patients in group B were significantly higher than those in group A and group C,the difference was statistically significant [(343.33±119.56)mg vs.(220.00±64.08)mg,(343.33±119.56)mg vs.(225.38±78.85)mg,P<0.05].But the doses of additional analgesics between patients in group A and C was not statistically significant [(220.00±64.08)mg vs.(225.38±78.85)mg,P>0.05].There was no significant difference in the length of hospital stay of the three groups of patients(P>0.05),the hospital stay was(12.85±8.57)d in group A,(15.00±15.14)d in group B,and(13.95±13.29)d in group C.Conclusion: Multimodal analgesia is an ideal plan for early pain management after thoracotomy.Continuous intercostal nerve block has a good effect in postoperative analgesia in patients undergoing thoracotomy.It can effectively reduce postoperative pain and reduce the amount of remedial analgesia.It is worthy of clinical application and promotion.