ABSTRACT
Introduction: Thoracic epidural block, paravertebral block, and intercostal nerve block have been confirmed to alleviate acute pain after video-assisted thoracoscopic surgery (VATS). In contrast, little is known about the effects of these methods on chronic post-surgical pain (CPSP). Aim: To investigate the effects of epidural block, paravertebral block, and intercostal nerve block on postoperative chronic pain in patients undergoing VATS. Material and methods: A total of 240 patients undergoing VATS were randomly divided into 4 groups: an epidural group, paravertebral group, intercostal group, and a control group. All patients were interviewed after 1, 3, 6, and 12 months to investigate the incidence and severity of CPSP. Results: The epidural group had lower incidence of chronic pain within 6 months and it was less severe within 3 months compared with the control group. The incidence and intensity of chronic pain within 3 months were lower in the intercostal group than in the control group. The incidence and intensity of pain within 1 month of surgery were lower in the paravertebral group than in the control group. Of the 122 patients who developed pain after 1 month, 93 (76.2%) reported chronic pain after 12 months, and only 9 (11.7%) had chronic pain after 12 months despite reporting no pain at 1 month. Conclusions: The prevalence of CPSP after VATS is high. Epidural block, paravertebral block, and intercostal nerve block can all reduce the incidence and severity of CPSP, with epidural block showing the best effect. In addition to acute pain, 1-month postoperative pain also exerts a warning effect on CPSP.
ABSTRACT
Background: Patients undergoing video-assisted thoracoscopic surgery (VATS) frequently suffered postoperative acute and chronic pains. In recent years, intrathoracic intercostal nerve block (INB) is regularly used thanks to its safety and accuracy, especially under the circumstance of lacking ultrasound or in face of the contraindications of the thoracic paravertebral block (TPVB). However, clinical evidence of comparing TPVB and INB for pain management after VATS has been limited and the observation of the chronic pain has been less than clear. Methods: A total of 180 patients undergoing VATS were randomly divided into three groups: A single multi-point paravertebral nerve block (Group P), intrathoracic intercostal nerve block (Group I), and general anesthesia without any regional block (Group C). Postoperative acute pain was scored at rest and coughing by the Visual Analog Scale (VAS) for recording 24h, 48h and 72h after VATS. All patients were interviewed 1, 3 and 6 months after the surgery to investigate both the incidence and intensity of chronic pains. Results: There were significantly less incidence and intensity of acute pain in Group P and Group I, compared to those in Group C. The patients in Group I showed the least incidence and intensity of chronic pain after 3 months compared with those in Group P and Group C. There are 89 of 98 patients suffering pains after 1 month, which grew into chronic pains after 3 months and 78 of them still suffered chronic pains even after 6 months. Conclusion: The intrathoracic INB offers excellent relief from acute and chronic pains, which does as effectively as TPVB. Besides, one-month postoperative pain could increase the risk of a chronic one.
ABSTRACT
The success of graphene oxide (GO) has attracted extensive research interests in developing novel 2D nanomaterials (NMs). Graphdiyne (GDY) is a new member of carbon-based 2D NMs possessing sp- and sp2 -hybridized carbon atoms. However, the toxicity of GDY is less investigated as GO. In this study, we compared the toxicity of GDY and GO with human umbilical vein endothelial cells (HUVECs). Exposure to up to 100-µg/ml GDY and GO induced cytotoxicity, but there was no statistically significant difference between GDY and GO. At noncytotoxic concentration, 25-µg/ml GDY or GO led to the internalization of NMs, typically in cytoplasm but not in nuclei. Only GO but not GDY significantly increased THP-1 adhesion onto NM-exposed HUVECs. Meanwhile, compared with GDY, GO more effectively promoted the release of soluble intracellular cell adhesion molecule-1 (sICAM-1), indicating the differential effects of GDY and GO on endothelial activation. Neither GDY nor GO induced intracellular superoxide. However, GO significantly promoted the expression of endoplasmic reticulum (ER) stress genes activating transcription factor 4 (ATF4) and X-box binding protein 1 spliced (XBP-1s), as well pyroptosis genes NLR family pyrin domain containing 3 (NLRP3) and gasdermin D (GSDMD), whereas GDY did not show this effect. The results suggested that GDY and GO could be internalized into HUVECs leading to cytotoxic effects. However, GO was more potent to activate endothelial activation probably due to the activation of ER stress and pyroptosis genes.
