胸外科电视辅助胸腔镜手术的术后镇痛进展
Advances in Postoperative Analgesia for Video-Assisted Thoracic Surgery in Thoracic Surgery
DOI: 10.12677/acm.2025.152499, PDF,   
作者: 陈 晞：延安大学医学院，陕西 延安；延安大学附属医院麻醉科，陕西 延安；高 慧, 郑 军*：延安大学附属医院麻醉科，陕西 延安
关键词: 电视辅助胸腔镜手术；术后镇痛；胸部；Video-Assisted Thoracic Surgery； Postoperative Analgesia； Chest
摘要: 开胸手术和电视辅助胸腔镜手术(video-assisted thoracic surgery, VATS)均会产生中度至重度以上的术后疼痛，影响患者康复，降低患者的医疗满意度。自1910年诞生以来，VATS以微创的方式逐步应用于肺、纵隔和胸膜等疾病。VATS虽然属于微创手术，疼痛程度明显小于开胸手术，但是术后疼痛程度依旧很高，多数患者难以忍受。镇痛不足可影响患者术后功能恢复和气道分泌物排出，从而导致患者发生局部肺不张、肺炎和肺栓塞等一系列并发症，甚至死亡率增加。因此，VATS的良好术后镇痛至关重要。本文对当前VATS常用术后镇痛的研究进展进行文献总结。
Abstract: Both open thoracic surgery and video-assisted thoracic surgery (video-assisted thoracic surgery, VATS) produce moderate to more than severe postoperative pain, which affects patient recovery and reduces patient medical satisfaction. Since its inception in 1910, VATS has been progressively applied in a minimally invasive manner to diseases of the lung, mediastinum and pleura. Although VATS is a minimally invasive procedure with a pain level significantly lower than that of open-heart surgery, the level of postoperative pain is still high and intolerable for most patients. Inadequate analgesia may affect the postoperative functional recovery and airway secretion discharge, which may lead to a series of complications such as localized pulmonary atelectasis, pneumonia and pulmonary embolism, and even increased mortality. Therefore, good postoperative analgesia for VATS is crucial. In this paper, we summarize the literature on the current research progress of postoperative analgesia commonly used in VATS.
文章引用：陈晞, 高慧, 郑军. 胸外科电视辅助胸腔镜手术的术后镇痛进展[J]. 临床医学进展, 2025, 15(2): 1474-1481. https://doi.org/10.12677/acm.2025.152499

参考文献

[1] Feray, S., Lubach, J., Joshi, G.P., Bonnet, F. and Van de Velde, M. (2021) PROSPECT Guidelines for Video‐Assisted Thoracoscopic Surgery: A Systematic Review and Procedure‐Specific Postoperative Pain Management Recommendations. Anaesthesia, 77, 311-325. [Google Scholar] [CrossRef] [PubMed]
[2] 安春荣. 术后疼痛原因分析与护理措施[J]. 中国冶金工业医学杂志, 2016, 33(1): 121-122.
[3] Kumar, S., Hameed, M., Shehzad, R. and Samad, K. (2023) The Comparison of the Analgesic Efficacy of Continuous Paravertebral Block Alone Compared with Continuous Paravertebral and Intercostal Nerve Block for Thoracotomy in Adults: A Randomized Controlled Trial. Journal of Anesthesia, 37, 923-929. [Google Scholar] [CrossRef] [PubMed]
[4] Baliki, M.N. and Apkarian, A.V. (2015) Nociception, Pain, Negative Moods, and Behavior Selection. Neuron, 87, 474-491. [Google Scholar] [CrossRef] [PubMed]
[5] Marshall, K. and McLaughlin, K. (2020) Pain Management in Thoracic Surgery. Thoracic Surgery Clinics, 30, 339-346. [Google Scholar] [CrossRef] [PubMed]
[6] Silomon, M., Claus, T., Huwer, H., Biedler, A., Larsen, R. and Molter, G. (2000) Interpleural Analgesia Does Not Influence Postthoracotomy Pain. Anesthesia & Analgesia, 91, 44-50. [Google Scholar] [CrossRef] [PubMed]
[7] Lederman, D., Easwar, J., Feldman, J. and Shapiro, V. (2019) Anesthetic Considerations for Lung Resection: Preoperative Assessment, Intraoperative Challenges and Postoperative Analgesia. Annals of Translational Medicine, 7, 356-356. [Google Scholar] [CrossRef] [PubMed]
[8] Butterworth, J.F., Mackey, D.C. and Wasnick, J.D. (2018) Morgan and Mikhail’s Clinical Anesthesiology. 6th Edition, McGraw Hill.
[9] Rawal, N. (2016) Current Issues in Postoperative Pain Management. European Journal of Anaesthesiology, 33, 160-171. [Google Scholar] [CrossRef] [PubMed]
[10] Fitzcharles, M., Cohen, S.P., Clauw, D.J., Littlejohn, G., Usui, C. and Häuser, W. (2021) Nociplastic Pain: Towards an Understanding of Prevalent Pain Conditions. The Lancet, 397, 2098-2110. [Google Scholar] [CrossRef] [PubMed]
[11] Peng, Z., Li, H., Zhang, C., Qian, X., Feng, Z. and Zhu, S. (2014) A Retrospective Study of Chronic Post-Surgical Pain Following Thoracic Surgery: Prevalence, Risk Factors, Incidence of Neuropathic Component, and Impact on Qualify of Life. PLOS ONE, 9, e90014. [Google Scholar] [CrossRef] [PubMed]
[12] Wang, H.-T., Liu, W., Luo, A.-L., Ma, C. and Huang, Y.-G. (2012) Prevalence and Risk Factors of Chronic Post-Thoracotomy Pain in Chinese Patients from Peking Union Medical College Hospital. Chinese Medical Journal, 125, 3033-3038.
[13] Bayman, E.O., Parekh, K.R., Keech, J., Selte, A. and Brennan, T.J. (2017) A Prospective Study of Chronic Pain after Thoracic Surgery. Anesthesiology, 126, 938-951. [Google Scholar] [CrossRef] [PubMed]
[14] 朱云柯, 林琳, 廖虎, 等. 中国胸外科围手术期疼痛管理专家共识(2018版) [J]. 中国胸心血管外科临床杂志, 2018, 25(11): 921-928.
[15] Jeleazcov, C., Ihmsen, H., Saari, T.I., Rohde, D., Mell, J., Fröhlich, K., et al. (2016) Patient-Controlled Analgesia with Target-Controlled Infusion of Hydromorphone in Postoperative Pain Therapy. Anesthesiology, 124, 56-68. [Google Scholar] [CrossRef] [PubMed]
[16] Jitpakdee, T. and Mandee, S. (2014) Strategies for Preventing Side Effects of Systemic Opioid in Postoperative Pediatric Patients. Pediatric Anesthesia, 24, 561-568. [Google Scholar] [CrossRef] [PubMed]
[17] De Andrade, R.R., de Oliveira Lima, N., Ribeiro, M.V.M.R., da Silva Ramos, F.W., de Sousa-Rodrigues, C.F. and Barbosa, F.T. (2022) Opioid-Free Postoperative Analgesia Compared to Traditional Analgesia after Thoracic Surgery: Scoping Review. Revista da Associação Médica Brasileira, 68, 1109-1114. [Google Scholar] [CrossRef] [PubMed]
[18] Schjerning, A., McGettigan, P. and Gislason, G. (2020) Cardiovascular Effects and Safety of (Non-Aspirin) Nsaids. Nature Reviews Cardiology, 17, 574-584. [Google Scholar] [CrossRef] [PubMed]
[19] 廖小勇, 葛明建. 胸外科术后镇痛研究进展[J]. 医学综述, 2018, 24(3): 581-585.
[20] Kohtala, S. (2021) Ketamine—50 Years in Use: From Anesthesia to Rapid Antidepressant Effects and Neurobiological Mechanisms. Pharmacological Reports, 73, 323-345. [Google Scholar] [CrossRef] [PubMed]
[21] Fjendbo Galili, S., Nikolajsen, L. and Papadomanolakis-Pakis, N. (2023) Subanaesthetic Single-Dose Ketamine as an Adjunct to Opioid Analgesics for Acute Pain Management in the Emergency Department: A Systematic Review and Meta-Analysis. BMJ Open, 13, e066444. [Google Scholar] [CrossRef] [PubMed]
[22] Altirkistani, B.A., Ashqar, A.A., Bahathiq, D.M., Bougis, S.M., Aljabri, A.M. and Hanafi, S. (2023) The Effectiveness of Ketamine versus Opioids in Patients with Acute Pain in the Emergency Department: A Systematic Review and Meta-Analysis. Cureus, 15, e36250. [Google Scholar] [CrossRef] [PubMed]
[23] Liu, X., Li, Y., Kang, L. and Wang, Q. (2021) Recent Advances in the Clinical Value and Potential of Dexmedetomidine. Journal of Inflammation Research, 14, 7507-7527. [Google Scholar] [CrossRef] [PubMed]
[24] Yan, G., Chen, J., Yang, G., Duan, G., Du, Z., Yu, Z., et al. (2018) Effects of Patient-Controlled Analgesia with Hydromorphone or Sufentanil on Postoperative Pulmonary Complications in Patients Undergoing Thoracic Surgery: A Quasi-Experimental Study. BMC Anesthesiology, 18, Article No. 192. [Google Scholar] [CrossRef] [PubMed]
[25] Zeltsman, M., Dozier, J., Vaghjiani, R.G., Poch, A., Eguchi, T., Pedoto, A., et al. (2020) Decreasing Use of Epidural Analgesia with Increasing Minimally Invasive Lobectomy: Impact on Postoperative Morbidity. Lung Cancer, 139, 68-72. [Google Scholar] [CrossRef] [PubMed]
[26] Wang, L., Wang, Y., Zhang, X., Zhu, X. and Wang, G. (2019) Serratus Anterior Plane Block or Thoracic Paravertebral Block for Postoperative Pain Treatment after Uniportal Video-Assisted Thoracoscopic Surgery: A Retrospective Propensity-Matched Study. Journal of Pain Research, 12, 2231-2238. [Google Scholar] [CrossRef] [PubMed]
[27] Spaans, L.N., Bousema, J.E., Meijer, P., Bouwman, R.A., van den Broek, R., Mourisse, J., et al. (2023) Acute Pain Management after Thoracoscopic Lung Resection: A Systematic Review and Explorative Meta-Analysis. Interdisciplinary CardioVascular and Thoracic Surgery, 36, ivad003. [Google Scholar] [CrossRef] [PubMed]
[28] 姜祎, 曲音音. 微创心胸外科手术区域阻滞镇痛的研究进展[J]. 中国微创外科杂志, 2022, 22(6): 499-504.
[29] Karmakar, M.K. (2001) Thoracic Paravertebral Block. Anesthesiology, 95, 771-780. [Google Scholar] [CrossRef] [PubMed]
[30] 张涛元, 张慧, 侯丽宏, 等. 椎旁神经阻滞用于心胸外科手术研究进展[J]. 临床麻醉学杂志, 2018, 34(10): 1024-1027.
[31] D’Ercole, F., Arora, H. and Kumar, P.A. (2018) Paravertebral Block for Thoracic Surgery. Journal of Cardiothoracic and Vascular Anesthesia, 32, 915-927. [Google Scholar] [CrossRef] [PubMed]
[32] Radkowski, P., Fadrowska-Szleper, M., Podhorodecka, K. and Mieszkowski, M. (2023) Neurological Complications of Regional Anesthesia: An Updated Review with Clinical Guidelines. Medical Science Monitor, 29, e940399. [Google Scholar] [CrossRef] [PubMed]
[33] Lin, J., Liao, Y., Gong, C., Yu, L., Gao, F., Yu, J., et al. (2022) Regional Analgesia in Video-Assisted Thoracic Surgery: A Bayesian Network Meta-Analysis. Frontiers in Medicine, 9, Article 842332. [Google Scholar] [CrossRef] [PubMed]
[34] Detterbeck, F.C. (2005) Efficacy of Methods of Intercostal Nerve Blockade for Pain Relief after Thoracotomy. The Annals of Thoracic Surgery, 80, 1550-1559. [Google Scholar] [CrossRef] [PubMed]
[35] Li, S., Feng, J., Fan, K., Fan, X., Cao, S. and Zhang, G. (2023) The Effect of Ultrasound-Guided Intercostal Nerve Block on Postoperative Analgesia in Thoracoscopic Surgery: A Randomized, Double-Blinded, Clinical Trial. Journal of Cardiothoracic Surgery, 18, Article No. 128. [Google Scholar] [CrossRef] [PubMed]
[36] Turhan, Ö., Sivrikoz, N., Sungur, Z., Duman, S., Özkan, B. and Şentürk, M. (2021) Thoracic Paravertebral Block Achieves Better Pain Control than Erector Spinae Plane Block and Intercostal Nerve Block in Thoracoscopic Surgery: A Randomized Study. Journal of Cardiothoracic and Vascular Anesthesia, 35, 2920-2927. [Google Scholar] [CrossRef] [PubMed]
[37] Jiang, T., Mo, X., Zhan, R., Zhang, Y. and Yu, Y. (2023) Regional Block Techniques for Pain Management after Video-Assisted Thoracoscopic Surgery: A Covariate-Adjusted Bayesian Network Meta-Analysis. Videosurgery and Other Miniinvasive Techniques, 18, 52-68. [Google Scholar] [CrossRef] [PubMed]
[38] Blanco, R., Parras, T., McDonnell, J.G. and Prats-Galino, A. (2013) Serratus Plane Block: A Novel Ultrasound-Guided Thoracic Wall Nerve Block. Anaesthesia, 68, 1107-1113. [Google Scholar] [CrossRef] [PubMed]
[39] Adhikary, S.D., Bernard, S., Lopez, H. and Chin, K.J. (2018) Erector Spinae Plane Block Versus Retrolaminar Block. Regional Anesthesia and Pain Medicine, 43, 756-762. [Google Scholar] [CrossRef] [PubMed]
[40] 张隆盛, 林旭林, 张欢楷, 等. 前锯肌平面阻滞与胸椎旁神经阻滞用于胸腔镜手术患者术后镇痛效果的比较[J]. 临床麻醉学杂志, 2019, 35(1): 47-51.
[41] Zengin, M., Sazak, H., Baldemir, R., Ulger, G. and Alagoz, A. (2022) The Effect of Erector Spinae Plane Block and Combined Deep and Superficial Serratus Anterior Plane Block on Acute Pain after Video-Assisted Thoracoscopic Surgery: A Randomized Controlled Study. Journal of Cardiothoracic and Vascular Anesthesia, 36, 2991-2999. [Google Scholar] [CrossRef] [PubMed]
[42] Qiu, L., Bu, X., Shen, J., Li, M., Yang, L., Xu, Q., et al. (2021) Observation of the Analgesic Effect of Superficial or Deep Anterior Serratus Plane Block on Patients Undergoing Thoracoscopic Lobectomy. Medicine, 100, e24352. [Google Scholar] [CrossRef] [PubMed]
[43] Forero, M., Adhikary, S.D., Lopez, H., Tsui, C. and Chin, K.J. (2016) The Erector Spinae Plane Block. Regional Anesthesia and Pain Medicine, 41, 621-627. [Google Scholar] [CrossRef] [PubMed]
[44] Saadawi, M., Layera, S., Aliste, J., Bravo, D., Leurcharusmee, P. and Tran, D.Q. (2021) Erector Spinae Plane Block: A Narrative Review with Systematic Analysis of the Evidence Pertaining to Clinical Indications and Alternative Truncal Blocks. Journal of Clinical Anesthesia, 68, Article 110063. [Google Scholar] [CrossRef] [PubMed]
[45] Gaballah, K.M., Soltan, W.A. and Bahgat, N.M. (2019) Ultrasound-Guided Serratus Plane Block versus Erector Spinae Block for Postoperative Analgesia after Video-Assisted Thoracoscopy: A Pilot Randomized Controlled Trial. Journal of Cardiothoracic and Vascular Anesthesia, 33, 1946-1953. [Google Scholar] [CrossRef] [PubMed]
[46] Maiwand, M.O., Makey, A.R. and Rees, A. (1986) Cryoanalgesia after Thoracotomy: Improvement of Technique and Review of 600 Cases. The Journal of Thoracic and Cardiovascular Surgery, 92, 291-295. [Google Scholar] [CrossRef] 
[47] Biel, E., Aroke, E.N., Maye, J. and Zhang, S.J. (2022) The Applications of Cryoneurolysis for Acute and Chronic Pain Management. Pain Practice, 23, 204-215. [Google Scholar] [CrossRef] [PubMed]
[48] Park, R., Coomber, M., Gilron, I. and Shanthanna, H. (2021) Cryoanalgesia for Postsurgical Pain Relief in Adults: A Systematic Review and Meta-Analysis. Annals of Medicine & Surgery, 69, Article 102689. [Google Scholar] [CrossRef] [PubMed]
[49] Ju, H., Feng, Y., Yang, B. and Wang, J. (2008) Comparison of Epidural Analgesia and Intercostal Nerve Cryoanalgesia for Post‐Thoracotomy Pain Control. European Journal of Pain, 12, 378-384. [Google Scholar] [CrossRef] [PubMed]
[50] Gwak, M.S., Yang, M., Hahm, T.S., Cho, H.S., Cho, C.H. and Song, J.G. (2004) Effect of Cryoanalgesia Combined with Intravenous Continuous Analgesia in Thoracotomy Patients. Journal of Korean Medical Science, 19, 74-78. [Google Scholar] [CrossRef] [PubMed]
[51] Paladini, G., Di Carlo, S., Musella, G., Petrucci, E., Scimia, P., Ambrosoli, A., et al. (2020) Continuous Wound Infiltration of Local Anesthetics in Postoperative Pain Management: Safety, Efficacy and Current Perspectives. Journal of Pain Research, 13, 285-294. [Google Scholar] [CrossRef] [PubMed]
[52] 中华医学会麻醉学分会. 成人手术后疼痛处理专家共识[J]. 临床麻醉学杂志, 2017, 33(9): 911-917.
[53] Fu, Z., Zhang, Y., Zhou, Y., Li, Z., Wang, K., Li, H., et al. (2022) A Comparison of Paravertebral Block, Erector Spinae Plane Block and the Combination of Erector Spinae Plane Block and Paravertebral Block for Post-Operative Analgesia after Video-Assisted Thoracoscopic Surgery: A Randomised Controlled Trial. Journal of Minimal Access Surgery, 18, 241-247. [Google Scholar] [CrossRef] [PubMed]
[54] Mo, X., Jiang, T., Wang, H. and Zhang, Y. (2023) Erector Spinae Plane Block Combined with Serratus Anterior Plane Block versus Thoracic Paravertebral Block for Postoperative Analgesia and Recovery after Thoracoscopic Surgery: A Randomized Controlled Non-Inferiority Clinical Trial. Current Medical Science, 43, 615-622. [Google Scholar] [CrossRef] [PubMed]

为你推荐