Analgesic effect of intercostal nerve block given preventively or at the end of operation in video-assisted thoracic surgery: a randomized clinical trial
Efeito analgésico do bloqueio do nervo intercostal administrado preventivamente ou no final da operação em cirurgia torácica videoassistida: ensaio clínico randomizado
Weizhang Xiao; Weiwei Zhou; Xinming Chen; Jun Zhu; Qun Xue; Jiahai Shi
Abstract
Objective
To compare the analgesic effect of intercostal nerve block (INB) with ropivacaine when given preventively or at the end of the operation in patients undergoing video-assisted thoracic surgery (VATS).
Methods
A total of 50 patients undergoing VATS were randomly divided into two groups. The patients in the preventive analgesia group (PR group) were given INB with ropivacaine before the intrathoracic manipulation combined with patient-controlled analgesia (PCA). The patients in the post-procedural block group (PO group) were administered INB with ropivacaine at the end of the operation combined with PCA. To evaluate the analgesic effect, postoperative pain was assessed with the visual analogue scale (VAS) at rest and Prince Henry Pain Scale (PHPS) scale at 6, 12, 24, 48, and 72 hours after surgery.
Results
At 6 h and 12 h post-surgery, the VAS at rest and PHPS scores in the PR group were significantly lower than those in the PO group. There were no significant differences in pain scores between two groups at 24, 48, and 72 hours post-surgery.
Conclusion
In patients undergoing VATS, preventive INB with ropivacaine provided a significantly better analgesic effect in the early postoperative period (at least through 12 h post-surgery) than did INB given at the end of surgery.
Keywords
Resumo
Objetivo: Comparar o efeito analgésico do bloqueio do nervo intercostal (BNI) com a ropivacaína quando administrado de forma preventiva ou no final da operação em pacientes submetidos à cirurgia torácica videoassistida (CTVA). Métodos: Um total de 50 pacientes submetidos a CTVA foram divididos aleatoriamente em dois grupos. Os pacientes do grupo de analgesia preventiva (grupo PR) receberam BNI com ropivacaína antes da manipulação intratorácica combinada com analgesia controlada pelo paciente (PCA). Os pacientes do grupo bloqueio pós-procedimento (grupo PO) receberam BNI com ropivacaína no final da operação combinada com ACP. Para avaliar o efeito analgésico, a dor pós-operatória foi avaliada com a escala visual analógica (EVA) em repouso e a escala Prince Henry Pain Scale (PHPS) às 6, 12, 24, 48 e 72 horas após a cirurgia. Resultados: Em 6 h e 12 h após a cirurgia, os escores da EVA em repouso e PHPS no grupo PR foram significativamente menores do que os do grupo PO. Não houve diferenças significativas nos escores de dor entre os dois grupos em 24, 48 e 72 horas após a cirurgia. Conclusão: Em pacientes submetidos a CTVA, BNI preventivo com ropivacaína proporcionou um efeito analgésico significativamente melhor no pós-operatório imediato (pelo menos até 12 h pós-cirurgia) do que BNI administrado no final da cirurgia.
Palavras-chave
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