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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.
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Humans , Nerve Block , Pain, Postoperative/prevention & control , Pain, Postoperative/drug therapy , Analgesia, Patient-Controlled , Thoracic Surgery, Video-Assisted , Ropivacaine , Analgesics , Intercostal NervesABSTRACT
@#Objective To compare the pain relief and rehabilitation effect of intercostal nerve block and conventional postoperative analgesia in patients undergoing thoracoscopic surgery. Methods China National Repository, Wanfang Database, VIP, China Biomedical Literature Database, Web of Science, Clinicaltrials.gov, Cochrane Library, EMbase and PubMed were searched from establishment of each database to 10 Febraray, 2022. Relevant randomized controlled trials (RCTs) of intercostal nerve block in thoracoscopic surgery were collected, and meta-analysis was conducted after data extraction and quality evaluation of the studies meeting the inclusion criteria. Results A total of 21 RCTs and one semi-randomized study were identified, including 1 542 patients. Performance bias was the main bias risk. Intercostal nerve block had a significant effect on postoperative analgesia in patients undergoing thoracoscopic surgery. The visual analogue scale (VAS) score at 12 h after surgery (MD=–1.45, 95%CI –1.88 to –1.02, P<0.000 01), VAS score at 24 h after surgery (MD=–1.28, 95%CI –1.67 to –0.89, P<0.000 01), and VAS score at 48 h after surgery significantly decreased (MD=–0.90, 95%CI –1.22 to –0.58, P<0.000 01). In exercise or cough state, VAS score at 24 h after surgery (MD=–2.40, 95%CI –2.66 to –2.14, P<0.000 01) and at 48 h after surgery decreased significantly (MD=–1.89, 95%CI –2.09 to –1.69, P<0.000 01). In the intercostal nerve block group, the number of compression of the intravenous analgesic automatic pump on the second day after surgery significantly reduced (SMD=–0.78, 95%CI –1.29 to –0.27, P=0.003). In addition to the analgesic pump, the amount of additional opioids significantly reduced (SMD=–2.05, 95%CI –3.65 to –0.45, P=0.01). Postoperative patient-controlled intravenous analgesia was reduced (SMD=–3.23, 95%CI –6.44 to –0.01, P=0.05). Patient satisfaction was significantly improved (RR=1.31, 95%CI 1.17 to 1.46, P<0.01). Chest tube indwelling time was significantly shortened (SMD=–0.64, 95%CI –0.84 to –0.45, P<0.001). The incidence of analgesia-related adverse reactions was significantly reduced (RR=0.43, 95%CI 0.33 to 0.56, P<0.000 01). Postoperative complications were significantly reduced (RR=0.28, 95%CI 0.18 to 0.44, P<0.000 01). Two studies showed that the length of hospital stay was significantly shortened in the intercostal nerve block group, which was statistically different (P≤0.05), and there was no statistical difference in one report. Conclusion The relief of acute postoperative pain and pain in the movement state is more prominent after intercostal nerve block. Intercostal nerve block is relatively safe and conforms to the concept of enhanced recovery after surgery, which can be extensively utilized in clinical practice.
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Objective:To investigate the effect of modified thoracic nerve block on postoperative analgesia and early recovery of breast cancer patients after modified radical mastectomy.Methods:Sixty female breast cancer patients who were scheduled to undergo modified radical mastectomy in the Second Hospital of Shanxi Medical University from March 2019 to December 2019 were selected, and the patients were all American Society of Anesthesiologists (ASA) grade Ⅰ-Ⅱ. According to the random number table method, the patients were divided into three groups: improved group [third rib approach serratus anterior plane block (SAPB)+pectoralis major muscle superficial anterior cutaneous branch of intercostal nerve block combined with general anesthesia, STG group], SAPB combined with general anesthesia group (SG group) and general anesthesia+postoperative intravenous controlled analgesia pump group (GP group), with 20 cases in each group. VAS scores at 30 min, 2 h, 4 h, 12 h and 24 h after surgery, 15-item quality of recovery scale (QoR-15) scores at 1 d before and 24 h after surgery, sleep duration on the night after surgery, intraoperative opioid dosage, the time between stop medication and awakening, postoperative flurbiprofen ester dosage, nausea, vomiting, dizziness, puncture site infection, pneumothorax, infection and other adverse reactions were recorded.Results:The VAS scores at 30 min, 2 h, 4 h, 12 h, 24 h in the STG group were lower than those in the SG group and GP group, the VAS scores at 2 h, 12 h and 24 h after surgery in the SG group were lower than those in the GP group, and the differences were statistically significant (all P < 0.05). The QoR-15 score at 24 h in the STG group was higher than that in the SG group and the GP group [(137.85±2.81) points vs. (134.80± 2.72) points, (133.80±5.16) points], and the differences were statistically significant (all P < 0.05). The sleep duration on the night after surgery in the STG group and the SG group was longer than that in the GP group [(6.03±0.90) h, (5.48±1.12) h vs. (3.85±1.76) h], and the differences were statistically significant (all P < 0.05). The intraoperative opioid dosage and the time between stop medication and awakening in the STG group and the SG group were lower than those in the GP group, and the differences were statistically significant (all P < 0.05). The postoperative flurbiprofen ester dosage and the incidence rates of nausea, vomiting and dizziness in the STG group were lower than those in the SG group and the GP group, and the SG group was lower than the GP group, and the differences were statistically significant (all P < 0.05). Conclusion:The modified thoracic nerve block can relieve early postoperative pain, reduce the amount of intraoperative opioids, and improve the quality of patients' early recovery without increasing adverse reactions.
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Background: Chest trauma is one of the serious injuries and also one of the leading causes of death from physical trauma. Current study is designed to study clinical profile, pattern of injuries, complications and treatment modality required in chest trauma management.Methods: A prospective observational study was conducted in Shri Vasantrao Naik Government Medical College, a tertiary care hospital in Yavatmal, Maharashtra, India in 246 patients primarily admitted for chest trauma from 1st March 2018 to 31st August 2019. All cases were managed in emergency department with history noted, clinical examination performed and initial management done as per ATLS guidelines. Definitive management done according to clinical and radiological investigations. Final outcome (death/discharge) was noted with discharged patients were followed until normal activity regained.Results: Male of 3rd-4th decade constituted most vulnerable group, with mean age of 38.56 years and male:female ratio of 5.31:1. Road traffic accident (RTA) was the commonest cause (71.14%), followed by assault (11.79%) and accidental fall (11.38%). Blunt force was the most common mechanism (93.09%). Rib fracture was present in 26.83%, lung contusion in 8.13% patients, followed by haemothorax (7.32%), hemopneumothorax (5.70%) and pneumothorax (3.25%). Conservative management suffices in most cases (86.59%), tube thoracostomy in 12.19%, thoracotomy in 1.22% cases. Patients with VAS score of 6 and above required intercostal nerve block (5.31%) or epidural analgesia (2.45%) for satisfactory pain relief. Pneumonia and atelectasis were common complications 2.03% each. Mortality rate was 1.22%. Average length of hospital stay was 4.6 days.Conclusions: Chest trauma commonly affects young males with RTA causing significant morbidity and mortality. Majority of patients can be treated conservatively.
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@#Objective To determine the effectiveness of continuous intercostal nerve block for pain relief after thoracotomy. Methods From November 2017 to October 2018, 120 patients who received thoracotomy procedure in our hospital were collected, including 60 males and 60 females aged 40-77 (58.10±7.00) years. The patients were randomly allocated into three groups by digital table including a continuous intercostal nerve block group (group A, n=40), a single intercostal nerve block group (group B, n=40), and an epidural analgesia group (group C, n=40). All the groups received the same basic analgesia. The pain scores and rescue analgesic doses were compared. Results On postoperative day (POD) 0, all groups achieved effective pain control, and the visual analogue score was 2.02±0.39 points in the group A, 2.13±0.75 points in the group B and 2.03±0.69 points in the group C (P>0.05). On POD 0-2 and POD 3-4 (without basement analgesia), there was no significant difference between the group A and group C in the pain scores (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 difference between POD 0-2 and POD 3-4 in each group was stastically different (group A, 2.08±0.28 points vs. 3.20±0.53 points; group B, 2.42±0.73 points vs. 5.45±0.99 points; group C 1.93±0.53 points vs. 3.46±0.47 points, P<0.05). In terms of the rescue analgesic doses, there was no significant difference between the group A and group C (220.00±64.08 mg vs. 225.38±78.85 mg, P>0.05); it was larger in the group B than that in the group A and group C (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). Conclusion Multimodal analgesia is an optimal choice in the initial stage after thoracotomy surgery. Continuous intercostal nerve block is an effective way to pain management in patients with thoracotomy.
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Objective To study the effects of dexmedetomidine combined with ropivacaine for intercostal nerve block on pain and sleep in patients with multiple ribs fracture. Methods One hundred and seventy-eight patients with multiple ribs fracture were divided into two groups according to the random digits table method: control group (ropivacaine, 88 cases) and experimental group (dexmedetomidine combined with ropivacaine, 90cases). On the second day after admission, the patient underwent intercostal nerve block guided by ultrasound. Pain score of resting pain, cough pain and night pain at each time point and the sleep condition was compared after 3 days. Results In 4—7 ribs fracture patients, the resting pain score in the experimental group was significantly lower than that in the control group within 16 hours: (1.3 ± 0.6)scores vs. (1.7 ± 0.7) scores, (2.1 ± 0.4) scores vs. (2.2 ± 0.6) scores, (2.2 ± 0.3) scores vs. (2.3 ± 0.3)scores; while in the cough pain score, the experimental group was significantly better than the control group within 24 hours: (1.6 ± 0.8) scores vs. (2.5 ± 0.9) scores, (3.0 ± 0.7) scores vs. (3.3 ± 0.8) scores, (3.3 ± 0.7) scores vs. (4.0 ± 0.9) scores, (4.9 ± 1.0) scores vs. (5.4 ± 1.0) scores. The differences were statistically significant (P<0.05). In patients with more than 7 ribs fractures, the resting pain scoreand cough pain score ,the experimental group were significantly better than those in the control group within 12 hours (P<0.05). On the first day and the second day after the block, the insomnia scores in the experimental group were significantly lower than those of the control group: (2.5 ± 0.7) scores vs. (4.2 ± 1.6) scores, (2.8 ± 0.8) scores vs. (4.5 ± 1.5) scores. The difference was statistically significant (χ2＝7.374, 7.989, P < 0.05) . Conclusions For patients with multiple ribs fracture, the use of dexmedetomidine combined with ropivacaine for intercostal nerve block can improve the analgesic effect, prolong the analgesic time, and improve sleep quality.
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Intercostal neuralgia is neuropathic pain that develops in the thorax and abdomen. It usually occurs as a result of injury or inflammation associated with the intercostal nerve triggered by trauma, surgery, or herpes zoster. Primary intercostal neuroma is a rare cause of intercostal neuralgia. A 69-year-old male patient without a history of thoracic trauma or surgery underwent repeated testing and intermittent treatment for refractory pain in the right chest and abdomen for several years. However, the treatment had limited effect. Abdominal computed tomography performed to diagnose recent pain aggravation revealed schwannoma of the 11th intercostal nerve. The patient's pain was relieved following surgical excision of the tumor.
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Aged , Humans , Male , Abdomen , Herpes Zoster , Inflammation , Intercostal Nerves , Neuralgia , Neurilemmoma , Neuroma , Pain, Intractable , ThoraxABSTRACT
Introduction: Thoracic epidural analgesia has greatly improved the pain experience and its consequences and has been considered the ‘gold standard’ for pain management after thoracotomy. This view has recently been challenged by the use of paravertebral nerve blocks. Nevertheless, severe ipsilateral shoulder pain and the prevention of post-thoracotomy pain syndrome remain the most important challenges for post-thoracotomy pain management. Aim of the study: To compare paravertebral block and continuous intercostal nerve block after thoracotomy. Materials and methods: Fifty adult patients undergoing elective posterolateral thoracotomy were randomized to receive either a continuous intercostal nerve blockade or a paravertebral block. Opioid consumption and postoperative pain were assessed for 48 hours. Pulmonary function was assessed by forced expiratory volume in 1 s (FEV1) recorded at 4 hours intervals. Results: With respect to the objective visual assessment (vas), both techniques were effective for post-thoracotomy pain. The average vas score at rest was 29±10 mm for paravertebral block and 31.5±11 mm for continuous intercostal nerve block. The average vas score on coughing was 36±14mm for the first one and 4 ±14 mm for the second group. Conclusion: Thoracic epidural analgesia or nerve blocks are so far considered as the best option but one needs to consider personnel and equipment resources available. A combination of local anesthetics along with opioids can be given to reduce the agony of the patient and early discharge from the hospital.
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To compare two methods of injecting ropivacaine as an intercostal nerve blocker, and for postoperative pain control after video-assisted thoracic surgery (VATS) in lung cancer patients. Methods: From August 2018 to November 2018, 60 patients who had undergone VATS with a diagnosis of lung cancer, were randomly assigned into two groups: control and test. After the surgery, the control group was injected with an intercostal nerve blocker (0.25% ropivacaine) via the inner thorax by the traditional method, and the test group was injected with ropivacaine via the outer thorax by an improved method. The pain scale was evaluated using the Visual Analogue Scale (VAS) and Prince Henry Pain Scale (PHPS) at 12 h (T1), 24 h (T2), 48 h (T3), and 72 h (T4) after the surgery. The dosage of administered morphine and the adverse effects of ropivacaine after surgery were also evaluated. Results: Injecting ropivacaine to the intercostal nerve by means of both, outer and inner thoracic injection showed satisfied analgesia, as evaluated by VAS and PHPS scores, and there were no significant differences between the two methods at any time point of analysis (T1-T4, P>0.05). The dosage of administered morphine and the time with chest tube were similar (P>0.05) between the groups. However, there were a few cases of subpleural hemorrhage in the test group. Conclusions: Intercostal nerve block with ropivacaine by means of both, outer and inner thoracic injection, showed satisfied analgesia, although, outer thoracic injection is more flexible with fewer complications.
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Objective To investigate the effect of intercostal nerve block combined with general anesthesia on hemodynamics in patients undergoing video-assisted thoracoscopic surgery. Method From January 2014 to January 2016, 100 patients were selected and divided into control group and experimental group according to the principle of complete random grouping. The patients in control group received general anesthesia with intravenous induction and static-occlusion, and the patients in experimental group received intercostal nerve block compound general anesthesia. The changes of visual analogue pain scores (VAS) and hemodynamics were evaluated in both groups. Changes in immune function before and after treatment were compared. Hemodynamic parameters include heart rate (HR), systolic blood pressure (SBP) and pulse oxygen saturation (SpO2). Immune function parameters include serum T cell subsets content. Results The VAS scores of the experimental group were significantly lower than those of the control group at different time points (P < 0.05). The systolic blood pressure and heart rate were significantly higher in the control group than those in the experimental group after the operation (P < 0.05). The CD4+, CD4+/CD8+levels in the test group were significantly higher than those in the control group (P < 0.05). Conclusion Intercostal nerve block composite anesthesia can better control the thoracoscopic patient's cardiovascular response and reduce the immune function inhibition. It is worthy of clinical promotion.
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<p><b>OBJECTIVE</b>To explore the correlation between efficacy of electroacupuncture (EA) on mammary gland hyperplasia (MGH) and the regulatory pathway of intercostal nerve.</p><p><b>METHODS</b>Fifty female SD rats were randomly divided into a blank group (group A, 12 rats), a model group (group B, 12 rats), an EA group (group C, 13 rats) and an intercostal nerve transection group (group D, 13 rats). The rats in the group B, group C and group D were prepared into MGH model; after model was successfully prepared, the 7th intercostal nerve was cut off in the group D. EA was applied at back acupoints including bilateral "Tianzong" (SI 11), "Ganshu" (BL 18) and "Shenshu" (BL 23) as well as chest acupoints including bilateral "Wuyi" (ST 15), "Hegu" (LI 4) and "Danzhong" (CV 17) in the group C and D. The two groups of acupoints were selected alternately. EA was given for 20 min, once a day; 5-day treatment was taken as one course; there was an interval of 2 days between course; totally 20 treatments were given. After treatment, the height and diameter of papilla were observed; the contents of serum estradiol (E) and progestin (P), the expression of estrogen receptor α (ERα) and progestrone receptor (PR) in mammary gland were measured.</p><p><b>RESULTS</b>(1) The height and diameter of papilla: after treatment, the height and diameter of papilla in the group C were significantly smaller than those in the group B (both<0.05); the height and diameter of left-side papilla in the group D were significantly bigger than those in the group C (both<0.05). (2) Serum Eand P: after treatment, compared with the group B, the contents of Eand E/P were reduced and the content of P was increased in the group C and group D (all<0.05). Compared with the group C, the contents of Eand E/P were increased and the content of P was reduced in the group D (all<0.05). (3) ERα and PR in mammary gland: compared with the group B, the content of ERαwas decreased and the content of PR was increased in the group C (both<0.05). Compared with the group C, the content of ERαwas increased and the content of PR was decreased in the group D ((both<0.05).</p><p><b>CONCLUSION</b>The efficacy mechanism of EA for MGH is likely to be related with the pathway of intercostal nerve; the mechanism may be acupuncture regulating the contents of serum Eand P as well as contents of ERα and PR in mammary gland.</p>
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@#Objective To analyze the outcome of fast track surgery after intercostal nerve block (INB) during thoracoscopic resection of lung bullae. Methods We recuited 76 patients who accepted thoracoscopic resection of lung bullae from February 2013 to March 2015. They were randomly divided into two groups: an intercostal nerve block and intravenous patient-controlled analgesia (INB+IPCA) group, in which 38 patients (30 males, 8 females, with a mean age of 23.63±4.10 years) received INB intraoperatively and IPCA postoperatively, and a postoperative intravenous patient-controlled analgesia (IPCA) group, in which 38 patients (33 males, 5 females, with a mean age of 24.93±6.34 years) only received IPCA postoperatively. Their general clinical data and the postoperative pain visual analogue scale (VAS) were recorded. Analgesia-associated side effects, rate of the pulmonary infection were observed. Expenses associated with analgesia during hospital were calculated. Results The score of VAS, the incidence of nausea and vomiting, fatigue and other side effects, pulmonary atelectasis and the infection rate in the INB+IPCA group were significantly lower than those in the IPCA group. Postoperative use of analgesic drugs was significantly less than that in the IPCA group. Medical expenses did not significantly increase. Conclusion INB+IPCA is beneficial for fast track surgery after thoracoscopic resection of lung bullae.
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Objective To investigate the effect of different doses of dexmedetomidine combined with intercostal nerve block in regional adenomammectomy.Methods 112 patients receiving regional adenomammectomy and meeting criterions were selected from Oct.2013 to Oct.2016.And they were divided into control group and low,medium,and high dose group according to table of random number,with 28 cases in each group.Patients of the control group only received intercostal nerve block.Patients of low dose group received low dose of dexmedetomidine (0.7 μg/kg load dose and 0.25μg· kg-1·h-1 maintenance doses) combined with intercostal nerve block.Patients of medium dose group received medium dose of dexmedetomidine (0.7 μg/kg load dose and 0.5 μg·kg-1·h-1 maintenance doses) combined with intercostal nerve block.Patients of high dose group received high dose of dexmedetomidine (0.7 μg/kg load dose and 1 μg· kg-1·h-1 maintenance doses) combined with intercostal nerve block.Mean arterial pressure,heart rate,VAS score and sedation score of the four groups were detected and compared at T0,T1,T2,T3 and T4.Results The mean arterial pressure and heart rate of medium and high dose group were lower than those of the control group and low dose group at T1,T2,T3 (P＜0.05).The mean arterial pressure and heart rate of high dose group were lower than those in medium dose group at T1,T2,T3 (P＜0.05).VAS score of medium and high dose group were lower than those of the control group and low dose group (P＜0.05),while the difference was not statistically significant between medium and high dose group(P＞0.05).The sedation scores of low,medium and high dose groups were higher than those of the control group at T1,T2,T3 and T4 (P＜0.05),while the sedation score of high dose group were higher than those of low and medium dose groups at T1,T2,T3 and T4 (P＜0.05).Conclusion Medium and high dose of dexmedetomidine combined intercostal nerve block can effectively relieve pain for patients undergoing regional adenomammectomy,while high dose of dexmedetomidine is likely to cause bradycardia,hypotension and excessive sedation.Appropriate dosage should be chosen in clinical practice.
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Objective:To investigate the effect of early postoperative cognitive dysfunction and postoperative analgesia situation after intercostal nerve block was applied on elderly patient received thoracic surgery.Methods: 105 elderly patients underwent thoracic surgeries were divided into observation group (35 patients received intercostal nerve block combined with general anesthesia), control A group (35 patients received epidural anesthesia combined with general anesthesia) and control B group (35 patients received routine general anesthesia). The cognitive function, postoperative pain, intraoperative mean artery pressure (MAP) and heart rate of the patients among different groups were respectively compared.Results: The cognitive function scores in postoperative 12h, 24h, 72h of observation group were significantly higher than that of control A group (t=20.917,t=27.780, t=74.081,P<0.05), respectively. And all of these data also were significantly higher than that of control B group (t=37.922,t=48.969,t=62.653,P<0.05), respectively. The differences of MAP, HR value between observation group and control A group were statistically significant (t=18.927,t=22.380,P<0.05), respectively. And the differences of them between observation group and control B group also were statistically significant (t=31.051, t=19.932, P<0.05), respectively. Besides, the differences of pain scores in postoperative 6h, 12h, 24h, 48h between observation group and control A group were not statistically significant, while all of pain scores of observation group were significantly lower than that of control B group (t=18.731,t=19.035, t=21.093,t=17.036;P<0.05).Conclusion:Intercostal nerve block combined with general anesthesia can ensure more stable intraoperative vital signs for elderly patients underwent thoracic surgeries, and it contributes to improve early cognitive function and possesses better postoperative analgesic effect for elderly patients.
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Objective To investigate the influence of pure intercostal nerve block combined with hydromorphone hydrochlo-ride intravenous analgesia on the occurrence of postoperative cognitive function and analgesia in elder patients with thoracic surger-y.Methods Ninety-six ASA I?Ⅱ elder patients with elective thoracic operation were divided into intercostal nerve block group (A),intercostal nerve block combined with hydromorphone hydrochloride intravenous analgesia group (B)and hydromorphone hydrochloride intravenous analgesia group(C)according to the random number table method,32 cases in each group.The patient-controlled intravenous analgesia(PCIA)with sufentanyl was postoperatively performed in all cases.When analgesia effect was poor, dezocine 0.1mg/kg was intravenously injected.The mean artery pressure(MAP),heart rate(HR),respiratory rate(RR),visual ana-logue scale (VAS)score and mini mental state examination (MMSE)score were recorded at postoperative 2,6,24,48 h in 3 groups.Results The MMSE score in the group B was higher than that in the group A and C,the VAS score was lower than that in the group A and C,the difference was statistically significant(P <0.05).Postoperative MAP and HR in the group B were more sta-ble than those in the group A and C,the difference was statistically significant(P <0.05).RR in the group C was more fast and had smaller range than those in the group A and B,the difference was statistically significant(P <0.05).Conclusion Intercostal nerve block combined with hydromorphone hydrochloride intravenous analgesia can achieve better postoperative analgesic effect with sta-ble postoperative blood dynamics and low occurrence rate of early postoperative cognitive dysfunction.
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Objective To discuss the clinical effect of artificial pneumothorax combined with intercostal nerve block in alleviating chest pain occurring during and after percutaneous microwave ablation (MWA) for subpleural lung malignancy.Methods A total of 30 patients with subpleural lung malignancy were randomly and equally divided into group A (n=10),group B (n=10) and group C (n=10).The patients in group A received both artificial pneumothorax and intercostal nerve block before MWA.The patients in group B only received artificial pneumothorax before MWA,and the patients in group C only received intercostal nerve block before MWA.The degree of pain was evaluated by visual analogue scale (VAS) score during MWA,immediately after MWA and at 6 h,12 h and 24 h after WMA.The side effects after MWA were recorded.Results During MWA,no statistically significant differences in VAS scores existed between each other among the three groups (P=0.885).The VAS scores determined at 6 h,12 h and 24 h after MWA in group C were significantly increased (P=0.014,P=0.006 and P=0.006 respectively).No patient in group A and group B developed symptoms of chest tightness after artificial pneumothorax was performed.After treatment,a small amount of asymptomatic residual pneumothorax was still observed in 6 patients of group A and group B,which disappeared spontaneously in about one week.Another patient still showed massive pneumothorax even after thoracic gas suction,and the patient recovered after thoracic closed drainage for three days.No other serious complications related to artificial pneumothorax occurred.Conclusion Artificial pneumothorax combined with intercostal nerve block can effectively relieve the chest pain occurring during and after MWA in patients with subpleural lung malignancy,and clinically this technique is quite safe.(J Intervent Radiol,2017,26:269-273)
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Abstract Background: Several locoregional techniques have been described for the management of acute and chronic pain after breast surgery. The optimal technique should be easy to perform, reproducible, with little discomfort to the patient, little complications, allowing good control of acute pain and a decreased incidence of chronic pain, namely intercostobrachial neuralgia for being the most frequent entity. Objectives: The aim of this study was to evaluate the paravertebral block with preoperative single needle prick for major breast surgery and assess initially the control of postoperative nausea and vomiting (PONV) and acute pain in the first 24 h and secondly the incidence of neuropathic pain in the intercostobrachial nerve region six months after surgery. Methods: The study included 80 female patients, ASA I-II, aged 18-70 years, undergoing major breast surgery, under general anesthesia, stratified into 2 groups: general anesthesia (inhalation anesthesia with opioids, according to hemodynamic response) and paravertebral (paravertebral block with single needle prick in T4 with 0.5% ropivacaine + adrenaline 3 µg mL−1 with a volume of 0.3 mL kg−1 preoperatively and subsequent induction and maintenance with general inhalational anesthesia). In the early postoperative period, patient-controlled analgesia (PCA) was placed with morphine set for bolus on demand for 24 h. Intraoperative fentanyl, postoperative morphine consumption, technique-related complications, pain at rest and during movement were recorded at 0 h, 1 h, 6 h and 24 h, as well as episodes of PONV. All variables identified as factors contributing to pain chronicity age, type of surgery, anxiety according to the Hospital Anxiety and Depression Scale (HADS), preoperative pain, monitoring at home; body mass index (BMI) and adjuvant chemotherapy/radiation therapy were analyzed, checking the homogeneity of the samples. Six months after surgery, the incidence of neuropathic pain in the intercostobrachial nerve was assessed using the DN4 scale. Results: The Visual Analog Scale (VAS) values of paravertebral group at rest were lower throughout the 24 h of study 0 h 1.90 (±2.59) versus 0.88 (±1.5) 1 h 2.23 (±2.2) versus 1.53 (±1.8) 6 h 1.15 (±1.3) versus 0.35 (±0.8); 24 h 0.55 (±0.9) versus 0.25 (±0.8) with statistical significance at 0 h and 6 h. Regarding movement, paravertebral group had VAS values lower and statistically significant in all four time points: 0 h 2.95 (±3.1) versus 1.55 (±2.1); 1 h 3.90 (±2.7) versus 2.43 (±1.9) 6 h 2.75 (±2.2) versus 1.68 (±1.5); 24 h 2.43 (±2.4) versus 1.00 (±1.4). The paravertebral group consumed less postoperative fentanyl (2.38 ± 0.81 µg kg−1 versus 3.51 ± 0.81 µg kg−1) and morphine (3.5 mg ± 3.4 versus 7 mg ± 6.4) with statistically significant difference. Chronic pain evaluation of at 6 months of paravertebral group found fewer cases of neuropathic pain in the intercostobrachial nerve region (3 cases versus 7 cases), although not statistically significant. Conclusions: Single-injection paravertebral block allows proper control of acute pain with less intraoperative and postoperative consumption of opioids but apparently it cannot prevent pain chronicity. Further studies are needed to clarify the role of paravertebral block in pain chronicity in major breast surgery.
Resumo Justificativa: Estão descritas várias técnicas locorregionais para a abordagem da dor aguda e dor crônica após cirurgia de mama. O ideal seria uma técnica fácil de fazer, reprodutível, com pouco desconforto para as doentes, com poucas complicações e que permitirá um bom controle da dor aguda e uma diminuição da incidência de dor crônica, notadamente dor neuropática do intercostobraquial, por ser a entidade mais frequente. Objetivos: Estudar a aplicação de bloqueio paravertebral com picada única no pré-operatório de cirurgia mamária de grande porte. Avaliar numa primeira fase o controle de dor aguda e náuseas-vômitos no pós-operatório (NVPO) nas primeiras 24 horas e numa segunda fase a incidência de dor neuropática na região do nervo intercostobraquial seis meses após a cirurgia. Métodos: Foram incluídas 80 doentes do sexo feminino, ASA I-II, entre 18 e 70 anos, submetidas a cirurgia mamária de grande porte sob anestesia geral, estratificadas em dois grupos: anestesia geral (anestesia geral inalatória com opioides segundo resposta hemodinâmica) e paravertebral (bloqueio paravertebral com picada única em T4 com ropivacaína 0,5% + adrenalina 3 µg/mL com um volume de 0,3 mL/kg pré-operatoriamente e posterior indução e manutenção com anestesia geral inalatória). No pós-operatório imediato foi colocada PCA (Patient-controlled analgesia) de morfina programada com bolus a demanda durante 24 horas. Foram registados fentanil intraoperatório, consumo de morfina pós-operatória, complicações relacionadas com as técnicas, dor em repouso e ao movimento a 0, 1 h, 6 h e 24 h, assim como os episódios de NVPO. Foram analisadas todas as variáveis identificadas como fatores de cronificação da dor idade, tipo de cirurgia, ansiedade segundo escala de HADS (Hospital Anxiety and Depression scale), dor pré-operatória; acompanhamento no domicílio; índice de massa corporal (IMC), tratamentos adjuvantes de quimioterapia/radioterapia e foi verificada a homogeneidade das amostras. Aos seis meses da cirurgia foi avaliada, segundo escala DN4, a incidência de dor neuropática na área do nervo intercostobraquial. Resultados: O grupo paravertebral teve valores de VAS (Escala Visual Analógica) em repouso mais baixos ao longo das 24 horas de estudo 0 h 1,90 (± 2,59) versus 0,88 (± 1,5); 1 h 2,23 (± 2,2) versus 1,53 (± 1,8); 6 h 1,15 (± 1,3) versus 0,35 (± 0,8); 24 h 0,55 (± 0,9) versus 0,25 (± 0,8) com significado estatístico às 0 e às 6 horas. Em relação ao movimento o grupo paravertebral teve valores de VAS mais baixos e com significância estatística nos quatro momentos de avaliação: 0 h 2,95 (± 3,1) versus 1,55 (± 2,1); 1 h 3,90 (± 2,7) versus 2,43 (± 1,9) 6 h 2,75 (± 2,2) versus 1,68 (± 1,5); 24 h 2,43 (± 2,4) versus 1,00 (± 1,4). O grupo paravertebral consumiu menos fentanil (2,38 ± 0,81 µg/Kg versus 3,51 ± 0,81 µg/Kg) e menos morfina no pós-operatório (3,5 mg ± 3,4 versus 7 mg ± 6,4), com diferença estatisticamente significativa. Na avaliação de dor crônica aos seis meses no grupo paravertebral houve menos casos de dor neuropática na região do nervo intercostobraquial (três versus sete) embora sem significância estatística. Conclusões: O bloqueio paravertebral com picada única permite um adequado controle da dor aguda com menor consumo de opioides intraopreatórios e pós-operatórios, mas aparentemente não consegue evitar a cronificação da dor. Mais estudos são necessários para esclarecer o papel do bloqueio paravertebral na cronificação da dor em cirurgia mamária de grande porte.
Subject(s)
Humans , Female , Adolescent , Adult , Aged , Young Adult , Pain, Postoperative/drug therapy , Brachial Plexus , Breast/surgery , Pain Management/methods , Intercostal Nerves , Nerve Block , Neuralgia/drug therapy , Acute Disease , Chronic Disease , Prospective Studies , Postoperative Nausea and Vomiting/drug therapy , Anesthesia, General , Middle Aged , Neuralgia/etiologyABSTRACT
Objective To analyze and discuss the effects of preserving the intercostobrachial nerve(ICBN)in modified radical mastectomy for breast cancer. Methods A total of 80 patients with breast cancer were randomly divided into the observation group and control group(n = 40 in each). The ICBN in the observation group were reserved and it was removed in the control group. Operation time,the number of lymph nodes,blood loss and complication rates were compared between groups. Two groups of patients were followed up for abnormal sensory function and relapse and metastasis. Results There were no differences in the operation time,the number of dissected lymph nodes and blood loss(P > 0. 05). There was no difference in complication rate(12. 50% vs 15. 00% )between the observation group and control group(P > 0. 05). There were significant differences in the incidence of abnormal sensory function at the first week(10. 00% vs 52. 50% ),the first month(5. 00% vs 47. 50% ),the third month(2. 50%vs 45. 50% ),the sixth month(2. 50% vs 37. 50% ),and the twelfth month(0. 00% vs 27. 50% )after op-eration between the observation group and control group(P < 0. 05). During the one-year follow-up peri-od,there was no relapse or metastasis. Conclusion Preserving ICBN in modified radical mastectomy can effectively reduce the incidence of abnormal sensory function of the upper limb.
ABSTRACT
Background and purpose:Many patients may suffer from acute pain after radical mastectomy un-der general anesthesia. This article aimed to investigate the effect of intercostal nerve block coupled with general anes-thesia on analgesia after radical mastectomy for breast cancer.Methods:Ninety-six patients underwent modiifed radical mastectomy for breast cancer were randomized with random number into group C (intercostal nerve block coupled with general anesthesia) and group G (general anesthesia), with 48 patients in each group. Group C received intercostal nerve block by ultrasound before general anesthesia. Group G received only general anesthesia. The induction of general an-esthesia was the same between the two groups. During the surgery, 10 μg sufentanil was given to the patient if heart rate or blood pressure were 20% higher than baseline. After surgery, sufentanil was given if VAS score exceeded 0 point. The perioperative amount of sufentanil was recorded. VAS scores were recorded respectively on 2 (T1), 12 (T2) and 24 h (T3) after surgery. The incidence of postoperative nausea and vomiting was also observed.Results:Sufentanil amount used intra- and post- operation were signiifcantly lower in group C [(25.2±3.5) and (3.3±1.2) μg] than that in group G [(40.5±4.3) and (8.4±2.2) μg] (P<0.01). The VAS scores on 2, 12 and 24 h after surgery in group C(0.45±0.15,1.75±0.08 and 2.05±0.12), were signiifcantly lower than those in group G (4.32±0.21, 4.88±0.13 and 4.78±0.16) (P<0.01). The incidences of nausea and vomiting on 2 and 24 h after surgery in group C (6.25% and 16.66%) were signiifcantly lower than those in group G (20.8% and 41.66%). There was no adverse complication related with intercostal nerve block in group C.Conclusion:Intercostal nerve block coupled with general anesthesia plays an important role in preemptive analgesia for patients undergoing modiifed radical mastectomy for breast cancer, which may improve postoperative pain control and reduce the usage of opioids and incidence of nausea and vomiting. Intercostal nerve block under ultrasound is quite safe and effective for patients.
ABSTRACT
Objective To provide anatomical basis for preventing paresthesia that appear in the lateral thoracic wall ,the arm‐pit and the inside of the upper arm during axillary lymph node dissection for breast cancer .Methods The intercostobrachial nerve (ICBN) and its contiguous relationship were observed ,besides the origin ,ramus and branch were measured and recorded by anato‐mizing 30 adult embalmed cadavers (60 sides) .Results Three intercostals nerve (50 sides) and the ICBN (29 sides) were the mainly nerves in lateral thoracic wall ,the medical brachial cutaneous nerve(MBCN) was not observed .Three intercostals nerve , ICBN(42 sides)and MBCN(44 sides) were found in armpit ,but mainly was intercostobrachial nerve (42 sides) .ICBN and the MB‐CN equally distributed in the dorsal and medical of the upper arm ,but the three intercostals nerve was not observed .81 .7% (49 sides) of intercostal nerve and all of the brachial plexus presenced filament .They existenced blood vessel accompanied when the ICBN pierced the chest wall (63 .3% ,38 sides) .Conclusion Identify and intactly preserve the ICBN and relevant nerves and their filament during axillary lymph node dissection of the breast cancer may benefit to prevent paresthesia .