Effect of intercostal nerve block on postoperative analgesia and outcome of fast track surgery after thoracoscopic surgery: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Jie , SUN Qingchao , LI Desheng , ZHANG Haiping , YU Fan ,  ZHANG Liwei

Department of Thoracic Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, P. R. China;

Corresponding?author：

ZHANG Liwei, Email: zhangliweixj@163.com

Keywords：

Thoracoscopic surgery; intercostal nerve block; enhanced recovery after surgery; pain management; randomized controlled trial; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202011012

Video：

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Abstract Full text Figures/Tables Video References Cited by

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.

Citation： LI Jie, SUN Qingchao, LI Desheng, ZHANG Haiping, YU Fan, ZHANG Liwei. Effect of intercostal nerve block on postoperative analgesia and outcome of fast track surgery after thoracoscopic surgery: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(4): 478-487. doi: 10.7507/1007-4848.202011012 Copy

1.	Yablonskii PK, Kudriashov GG, Avetisyan AO. Surgical resection in the treatment of pulmonary tuberculosis. Thorac Surg Clin, 2019, 29(1): 37-46.
2.	Reinersman JM, Passera E, Rocco G. Overview of uniportal video-assisted thoracic surgery (VATS): Past and present. Ann Cardiothorac Surg, 2016, 5(2): 112-117.
3.	Liu F, Zhang J, Zhang HK, et al. Thoracic paravertebral block in the PACU for immediate postoperative pain relief after video-assisted thoracoscopic surgery. Zhonghua Yi Xue Za Zhi, 2017, 97(2): 119-122.
4.	Palade E, Guenter J, Kirschbaum A, et al. Postoperative pain in the acute phase after surgery: VATS lobectomy vs. open lung resection—Results of a prospective randomised trial. Zentralbl Chir, 2014, 139 (Suppl 1): S59-S66.
5.	Vogt A, Stieger DS, Theurillat C, et al. Single-injection thoracic paravertebral block for postoperative pain treatment after thoracoscopic surgery. Br J Anaesth, 2005, 95(6): 816-821.
6.	Macrae WA. Chronic post-surgical pain: 10 years on. Br J Anaesth, 2008, 101(1): 77-86.
7.	謝曉平, 陳天慶, 邱海平, 等. 羅哌卡因肋間神經阻滯對單孔胸腔鏡術后患者 SP、PGI2、NPY 水平及 VAS 評分、Prince-Henry 評分的影響. 現代醫學, 2018, 46(6): 616-620.
8.	劉丹, 屈新明, 秦威, 等. 術中肋間神經阻滯對胸腔鏡肺大皰切除術后快速康復效果的隨機對照試驗. 中國胸心血管外科臨床雜志, 2017, 24(9): 696-700.
9.	劉延莉, 張麗紅, 李曉征, 等. 胸腔鏡直視下置管行連續肋間神經阻滯對肺葉切除術患者鎮痛效果及術后康復的影響. 中國現代手術學雜志, 2019, 23(6): 423-427.
10.	于亮, 何偉, 張升, 等. 肋間神經阻滯在肺癌胸腔鏡手術的臨床應用研究. 中國保健營養, 2016, 26(22): 143.
11.	徐華陽, 周小平, 程功文. 肋間神經阻滯超前鎮痛在胸腔鏡肺大泡切除手術中的臨床觀察. 中國現代醫生, 2019, 57(3): 109-111, 118.
12.	米芳, 劉敏, 張淑云, 等. 胸腔鏡肺段切除手術后多模鎮痛的臨床研究. 中華胸部外科電子雜志, 2020, 7(1): 30-35.
13.	李躍, 宮立群, 徐鋒, 等. 羅哌卡因肋間神經阻滯對肺癌患者胸腔鏡術后鎮痛效果的影響. 中國腫瘤臨床, 2017, 44(12): 605-607.
14.	曹雷, 李成輝. 肋間神經阻滯聯合靜脈自控鎮痛應用于胸腔鏡肺大皰切除術后鎮痛的效果觀察. 廣西醫學, 2013, (10): 1361-1362.
15.	傅海青, 岑盛華, 梁磊. 肋間神經阻滯復合全身麻醉對胸腔鏡手術患者血流動力學的影響. 中國內鏡雜志, 2018, 24(1): 70-74.
16.	卜小琨. 肋間神經阻滯超前鎮痛在胸腔鏡肺大皰切除手術中的應用效果觀察. 醫藥前沿, 2019, 9(33): 125-126.
17.	段秀麗. 羅派卡因局部麻醉在胸腔鏡下胸膜剝脫術后鎮痛的效果研究. 健康大視野, 2019, (22): 194-195.
18.	董瑩. 術中肋間神經阻滯聯合術后靜脈使用鎮痛泵對胸腔鏡術后鎮痛效果的觀察. 中外醫學研究, 2019, 17(26): 12-14.
19.	徐恒. 術中肋間神經阻滯對胸腔鏡肺葉切除術后鎮痛效果的臨床觀察. 大連醫科大學, 2018.
20.	陳冀衡, 張云宵, 李萍, 等. 胸椎旁神經阻滯或肋間神經阻滯復合全麻對胸腔鏡手術患者術后鎮痛的影響. 臨床麻醉學雜志, 2014, 30(5): 444-447.
21.	周時蓓. 肋間神經阻滯復合靜脈自控鎮痛對胸腔鏡手術患者術后鎮痛效果的觀察. 復旦大學, 2008.
22.	何禹成. 局部冷療聯合肋間神經阻滯及靜脈自控鎮痛在胸腔鏡術后鎮痛的應用. 西南醫科大學, 2018.
23.	馬明志. 肋間神經阻滯聯合靜脈自控鎮痛對胸腔鏡術后患者鎮痛效果觀察. 中國現代醫生, 2009, 47(30): 89-90.
24.	陸孝陳, 倪斌, 馬海濤, 等. 持續肋間神經阻滯在胸腔鏡手術中的應用. 中華胸心血管外科雜志, 2013, 29(6): 382-383.
25.	賈立明, 郭永清, 郝洪鐘, 等. 多模式鎮痛對胸腔鏡下肺大皰切除術患者術后鎮痛效果的觀察. 山西醫藥雜志, 2015, 44(7): 795-797.
26.	段李明, 丁超, 韋林, 等. 術中肋間神經阻滯在單操作孔胸腔鏡肺楔形切除術中的臨床應用. 重慶醫學, 2020, 49(20): 3445-3447.
27.	巫旋欽, 陳中良, 陳庚, 等. 術中肋間神經阻滯在單孔胸腔鏡肺楔形切除術中的臨床應用效果. 醫學食療與健康, 2021, 19(18): 45-46.
28.	蔡棟江, 趙和平, 俞米林. 肋間神經阻滯聯合全麻在肺癌胸腔鏡手術中的臨床應用. 浙江創傷外科, 2021, 26(1): 168-170.
29.	Andrews WG, Paul S. Techniques of video-assisted thoracoscopic surgery lobectomy and critical review of published data. Future Oncol, 2016, 12(23s): 31-33.
30.	Slim K. Fast-track surgery: The next revolution in surgical care following laparoscopy. Colorectal Dis, 2011, 13(5): 478-480.
31.	Du N, Rao Z, Che G, et al. What is result: Short-term medium chain triglyceride diet effective on postoperative outcome in lung cancer surgery? A prospective randomized study. Zhongguo Fei Ai Za Zhi, 2016, 19(12): 821-826.
32.	Houri K, Hamasaki S, Tsujimoto T, et al. A spinal cord infarction that occurred after laparoscopic gastrectomy performed under general anesthesia and epidural analgesia. JA Clin Rep, 2018, 4(1): 6.
33.	Kelly ME, Mc Nicholas D, Killen J, et al. Thoracic paravertebral blockade in breast surgery: Is pneumothorax an appreciable concern? A review of over 1000 cases. Breast J, 2018, 24(1): 23-27.
34.	中華醫學會麻醉學分會. 成人術后疼痛處理專家共識. 臨床麻醉學雜志, 2010, 26(3): 190-196.
35.	Kol E, Erdogan A, Karsl? B. Nature and intensity of the pain following thoracotomy. Int J Nurs Pract, 2012, 18(1): 84-90.
36.	Chen S, Zhu X, Huang L, et al. Optimal dose of ropivacaine for relieving cough-pain after video-assisted thoracoscopic lobectomy by single intrapleural injection: A randomized, double-blind, controlled study. Int J Surg, 2019, 69: 132-138.

1. Yablonskii PK, Kudriashov GG, Avetisyan AO. Surgical resection in the treatment of pulmonary tuberculosis. Thorac Surg Clin, 2019, 29(1): 37-46.
2. Reinersman JM, Passera E, Rocco G. Overview of uniportal video-assisted thoracic surgery (VATS): Past and present. Ann Cardiothorac Surg, 2016, 5(2): 112-117.
3. Liu F, Zhang J, Zhang HK, et al. Thoracic paravertebral block in the PACU for immediate postoperative pain relief after video-assisted thoracoscopic surgery. Zhonghua Yi Xue Za Zhi, 2017, 97(2): 119-122.
4. Palade E, Guenter J, Kirschbaum A, et al. Postoperative pain in the acute phase after surgery: VATS lobectomy vs. open lung resection—Results of a prospective randomised trial. Zentralbl Chir, 2014, 139 (Suppl 1): S59-S66.
5. Vogt A, Stieger DS, Theurillat C, et al. Single-injection thoracic paravertebral block for postoperative pain treatment after thoracoscopic surgery. Br J Anaesth, 2005, 95(6): 816-821.
6. Macrae WA. Chronic post-surgical pain: 10 years on. Br J Anaesth, 2008, 101(1): 77-86.
7. 謝曉平, 陳天慶, 邱海平, 等. 羅哌卡因肋間神經阻滯對單孔胸腔鏡術后患者 SP、PGI2、NPY 水平及 VAS 評分、Prince-Henry 評分的影響. 現代醫學, 2018, 46(6): 616-620.
8. 劉丹, 屈新明, 秦威, 等. 術中肋間神經阻滯對胸腔鏡肺大皰切除術后快速康復效果的隨機對照試驗. 中國胸心血管外科臨床雜志, 2017, 24(9): 696-700.
9. 劉延莉, 張麗紅, 李曉征, 等. 胸腔鏡直視下置管行連續肋間神經阻滯對肺葉切除術患者鎮痛效果及術后康復的影響. 中國現代手術學雜志, 2019, 23(6): 423-427.
10. 于亮, 何偉, 張升, 等. 肋間神經阻滯在肺癌胸腔鏡手術的臨床應用研究. 中國保健營養, 2016, 26(22): 143.
11. 徐華陽, 周小平, 程功文. 肋間神經阻滯超前鎮痛在胸腔鏡肺大泡切除手術中的臨床觀察. 中國現代醫生, 2019, 57(3): 109-111, 118.
12. 米芳, 劉敏, 張淑云, 等. 胸腔鏡肺段切除手術后多模鎮痛的臨床研究. 中華胸部外科電子雜志, 2020, 7(1): 30-35.
13. 李躍, 宮立群, 徐鋒, 等. 羅哌卡因肋間神經阻滯對肺癌患者胸腔鏡術后鎮痛效果的影響. 中國腫瘤臨床, 2017, 44(12): 605-607.
14. 曹雷, 李成輝. 肋間神經阻滯聯合靜脈自控鎮痛應用于胸腔鏡肺大皰切除術后鎮痛的效果觀察. 廣西醫學, 2013, (10): 1361-1362.
15. 傅海青, 岑盛華, 梁磊. 肋間神經阻滯復合全身麻醉對胸腔鏡手術患者血流動力學的影響. 中國內鏡雜志, 2018, 24(1): 70-74.
16. 卜小琨. 肋間神經阻滯超前鎮痛在胸腔鏡肺大皰切除手術中的應用效果觀察. 醫藥前沿, 2019, 9(33): 125-126.
17. 段秀麗. 羅派卡因局部麻醉在胸腔鏡下胸膜剝脫術后鎮痛的效果研究. 健康大視野, 2019, (22): 194-195.
18. 董瑩. 術中肋間神經阻滯聯合術后靜脈使用鎮痛泵對胸腔鏡術后鎮痛效果的觀察. 中外醫學研究, 2019, 17(26): 12-14.
19. 徐恒. 術中肋間神經阻滯對胸腔鏡肺葉切除術后鎮痛效果的臨床觀察. 大連醫科大學, 2018.
20. 陳冀衡, 張云宵, 李萍, 等. 胸椎旁神經阻滯或肋間神經阻滯復合全麻對胸腔鏡手術患者術后鎮痛的影響. 臨床麻醉學雜志, 2014, 30(5): 444-447.
21. 周時蓓. 肋間神經阻滯復合靜脈自控鎮痛對胸腔鏡手術患者術后鎮痛效果的觀察. 復旦大學, 2008.
22. 何禹成. 局部冷療聯合肋間神經阻滯及靜脈自控鎮痛在胸腔鏡術后鎮痛的應用. 西南醫科大學, 2018.
23. 馬明志. 肋間神經阻滯聯合靜脈自控鎮痛對胸腔鏡術后患者鎮痛效果觀察. 中國現代醫生, 2009, 47(30): 89-90.
24. 陸孝陳, 倪斌, 馬海濤, 等. 持續肋間神經阻滯在胸腔鏡手術中的應用. 中華胸心血管外科雜志, 2013, 29(6): 382-383.
25. 賈立明, 郭永清, 郝洪鐘, 等. 多模式鎮痛對胸腔鏡下肺大皰切除術患者術后鎮痛效果的觀察. 山西醫藥雜志, 2015, 44(7): 795-797.
26. 段李明, 丁超, 韋林, 等. 術中肋間神經阻滯在單操作孔胸腔鏡肺楔形切除術中的臨床應用. 重慶醫學, 2020, 49(20): 3445-3447.
27. 巫旋欽, 陳中良, 陳庚, 等. 術中肋間神經阻滯在單孔胸腔鏡肺楔形切除術中的臨床應用效果. 醫學食療與健康, 2021, 19(18): 45-46.
28. 蔡棟江, 趙和平, 俞米林. 肋間神經阻滯聯合全麻在肺癌胸腔鏡手術中的臨床應用. 浙江創傷外科, 2021, 26(1): 168-170.
29. Andrews WG, Paul S. Techniques of video-assisted thoracoscopic surgery lobectomy and critical review of published data. Future Oncol, 2016, 12(23s): 31-33.
30. Slim K. Fast-track surgery: The next revolution in surgical care following laparoscopy. Colorectal Dis, 2011, 13(5): 478-480.
31. Du N, Rao Z, Che G, et al. What is result: Short-term medium chain triglyceride diet effective on postoperative outcome in lung cancer surgery? A prospective randomized study. Zhongguo Fei Ai Za Zhi, 2016, 19(12): 821-826.
32. Houri K, Hamasaki S, Tsujimoto T, et al. A spinal cord infarction that occurred after laparoscopic gastrectomy performed under general anesthesia and epidural analgesia. JA Clin Rep, 2018, 4(1): 6.
33. Kelly ME, Mc Nicholas D, Killen J, et al. Thoracic paravertebral blockade in breast surgery: Is pneumothorax an appreciable concern? A review of over 1000 cases. Breast J, 2018, 24(1): 23-27.
34. 中華醫學會麻醉學分會. 成人術后疼痛處理專家共識. 臨床麻醉學雜志, 2010, 26(3): 190-196.
35. Kol E, Erdogan A, Karsl? B. Nature and intensity of the pain following thoracotomy. Int J Nurs Pract, 2012, 18(1): 84-90.
36. Chen S, Zhu X, Huang L, et al. Optimal dose of ropivacaine for relieving cough-pain after video-assisted thoracoscopic lobectomy by single intrapleural injection: A randomized, double-blind, controlled study. Int J Surg, 2019, 69: 132-138.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effect of intercostal nerve block on postoperative analgesia and outcome of fast track surgery after thoracoscopic surgery: A systematic review and meta-analysis

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