Effectiveness of intercostal nerve block and analgesia with bupivacaine liposomes in single-port thoracoscopic lung surgery: A prospective study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 LU Jianguo , ZHAO Xiangmei , GAN Shaoyin , CHEN Xiaofang , ZHU Deqi , YAN Ershuai , LI Xiaojie

Department of Thoracic Surgery, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453100, Henan, P. R. China;

Corresponding?author：

LU Jianguo, Email: doctorlujianguo@163.com

Keywords：

Single-port thoracoscopic lung surgery; liposome bupivacaine; bupivacaine hydrochloride; intercostal nerve block

DOI：

10.7507/1007-4848.202403051

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To compare the analgesic effect, duration and incidence of adverse reactions of liposome bupivacaine (LB) and bupivacaine hydrochloride after intercostal nerve block in single-port thoracoscopic lung surgery. Methods In Department of Thoracic Surgery of the First Affiliated Hospital of Xinxiang Medical University between September 2023 and March 2024, 228 patients who needed to undergo thoracoscopic lung surgery were selected and divided into two groups by random number table method: a group B with bupivacaine hydrochloride (n=118), and a group LB with LB (n=110). Intraoperative intercostal nerve block was performed under endoscopy, and the time of first use of analgesic drugs after surgery, cumulative use of opioids 72 h after surgery, incidence of postoperative nausea and vomiting, length of stay and other indicators were evaluated and recorded. Results Visual analogue scale (VAS) scores at 4 h, 8 h, 12 h, 24 h, 48 h and 72 h in the LB group were significantly lower than those in the group B (P<0.05). The total number of activities within 48 h after surgery in the group B was significantly lower than that in the LB group (P<0.05), and the postoperative hospitalization stay in the LB group was shorter than that in the group B, but the difference was not statistically significant. There was no statistical difference between the two groups in postoperative adverse reactions. Conclusion Intercostal nerve block with LB during single-port thoracoscopic lung surgery can significantly reduce postoperative pain, improve quality of life, and promote recovery of the patients. It is worthy of clinical application.

Citation： LU Jianguo, ZHAO Xiangmei, GAN Shaoyin, CHEN Xiaofang, ZHU Deqi, YAN Ershuai, LI Xiaojie. Effectiveness of intercostal nerve block and analgesia with bupivacaine liposomes in single-port thoracoscopic lung surgery: A prospective study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(10): 1442-1447. doi: 10.7507/1007-4848.202403051 Copy

1.	Cao W, Chen HD, Yu YW, et al. Changing profiles of cancer burden worldwide and in China: A secondary analysis of the global cancer statistics 2020. Chin Med J (Engl), 2021, 34(7): 783-791.
2.	劉飛, 張靜, 張歡楷, 等. 超聲引導胸椎旁阻滯治療胸腔鏡手術后早期中重度急性疼痛的療效觀察. 中華醫學雜志, 2017, 97(2): 4.Liu F, Zhang J, Zhang HK, et al. Thoracic paravertebral block in the PACU for immediate postoperative pain relief after video-assisted thoracoscopic surgery. Chin Med J, 2017, 97(2): 4.
3.	Xiao W, Zhou W, Chen X, et al. Analgesic effect of intercostal nerve block given preventively or at the end of operation in video-assisted thoracic surgery: A randomized clinical trial. Braz J Anesthesiol, 2022, 72(5): 574-578.
4.	宗華, 高云飛, 哈斯艷·圖爾遜, 等. 基于ERAS模式下探討豎脊肌與神經阻滯麻醉對VATS手術患者鎮痛、細胞因子及并發癥的影響. 新疆醫科大學學報, 2022, 45(3): 281-285.Zong H, Gao YF, Hasyan T, et al. Explore effects of erector spinal muscle and nerve block anesthesia on analgesia, cytokines and complications in patients undergoing VATS surgery based on ERAS mode. J Xinjiang Med Univ, 2022, 45(3): 281-285.
5.	岳菡, 王丹, 姚丹, 等. 靜脈全麻聯合超聲引導下前鋸肌平面+肋間神經阻滯應用于胸腔鏡肺楔形切除術效果分析. 現代生物醫學進展, 2023, 23(14): 2677-2682.Yue H, Wang D, Yao D, et al. Effect analysis of anterior serserus plane block and intercostal nerve block under intravenous general anesthesia combined with ultrasound guidance in thoracoscopic cuneform resection of lung. Prog Mod Biomed, 2023, 23(14): 2677-2682.
6.	Madabushi R, Tewari S, Gautam SK, et al. Serratus anterior plane block: A new analgesic technique for post-thoracotomy pain. Pain Physician, 2015, 18(3): E421-E424.
7.	許晴雯, 占樂云, 馬會芹. 超聲引導下區域阻滯在胸科手術后鎮痛的臨床應用進展. 麻醉安全與質控, 2018, 2(6): 5.Xu QW, Zhan LY, Ma HQ. Clinical application of ultrasound-guided regional block for analgesia of thoracic surgery. Periop Safe Qual Assur, 2018, 2(6): 5.
8.	馬培奇. 美 FDA 批準布比卡因脂質體注射用懸浮液 Exparel 治療術后疼痛. 上海醫藥, 2012, 33(15): 29.Ma PQ. FDA approves bupivacaine liposome injection suspension Exparel for the treatment of postoperative pain. Shanghai Med Pharmaceutic J, 2012, 33(15): 29.
9.	Jasper AO, Onohwakpor EA, Akhator A. High-risk surgeries, anesthetic challenges, and real benefits of peripheral regional techniques revisited. Niger J Clin Pract, 2021, 24(5): 782-785.
10.	Echeverria-Villalobos M, Stoicea N, Todeschini AB, et al. Enhanced recovery after surgery (ERAS): A perspective review of postoperative pain management under ERAS pathways and its role on opioid crisis in United States. Clin J Pain, 2019, 36(3): 1.
11.	Zhen SQ, Jin M, Chen YX, et al. Ultrasound-guided paravertebral nerve block anesthesia on the stress response and hemodynamics among lung cancer patients. World J Clin Cases, 2022, 10(7): 2174-2183.
12.	Peter V, SylviaD A, Loay M , et al. Management of a parenteral opioid shortage using ASHP guidelines. A Am J Health Syst Pharm, 2021, 78(5): 426-435.
13.	張黃麗, 殷昌生, 賈曉姝, 等. 布比卡因脂質體術后鎮痛應用進展. 武警醫學, 2023, 34(6): 530-534.Zhang HL, Yin CS, Jia XS, et al. Progress in postoperative analgesia with bupivacaine liposome. Med J Chin People's Arm, 2023, 34(6): 530-534.
14.	Sun L, Mu J, Gao B, et al. Comparison of the efficacy of ultrasound-guided erector spinae plane block and thoracic paravertebral block combined with intercostal nerve block for pain management in video-assisted thoracoscopic surgery: A prospective, randomized, controlled clinical trial. BMC Anesthesiol, 2022, 22(1): 283.
15.	Li S, Feng J, Fan K, et al. The effect of ultrasound-guided intercostal nerve block on postoperative analgesia in thoracoscopic surgery: A randomized, double-blinded, clinical trial. J Cardiothorac Surg, 2023, 18(1): 128.

1. Cao W, Chen HD, Yu YW, et al. Changing profiles of cancer burden worldwide and in China: A secondary analysis of the global cancer statistics 2020. Chin Med J (Engl), 2021, 34(7): 783-791.
2. 劉飛, 張靜, 張歡楷, 等. 超聲引導胸椎旁阻滯治療胸腔鏡手術后早期中重度急性疼痛的療效觀察. 中華醫學雜志, 2017, 97(2): 4.Liu F, Zhang J, Zhang HK, et al. Thoracic paravertebral block in the PACU for immediate postoperative pain relief after video-assisted thoracoscopic surgery. Chin Med J, 2017, 97(2): 4.
3. Xiao W, Zhou W, Chen X, et al. Analgesic effect of intercostal nerve block given preventively or at the end of operation in video-assisted thoracic surgery: A randomized clinical trial. Braz J Anesthesiol, 2022, 72(5): 574-578.
4. 宗華, 高云飛, 哈斯艷·圖爾遜, 等. 基于ERAS模式下探討豎脊肌與神經阻滯麻醉對VATS手術患者鎮痛、細胞因子及并發癥的影響. 新疆醫科大學學報, 2022, 45(3): 281-285.Zong H, Gao YF, Hasyan T, et al. Explore effects of erector spinal muscle and nerve block anesthesia on analgesia, cytokines and complications in patients undergoing VATS surgery based on ERAS mode. J Xinjiang Med Univ, 2022, 45(3): 281-285.
5. 岳菡, 王丹, 姚丹, 等. 靜脈全麻聯合超聲引導下前鋸肌平面+肋間神經阻滯應用于胸腔鏡肺楔形切除術效果分析. 現代生物醫學進展, 2023, 23(14): 2677-2682.Yue H, Wang D, Yao D, et al. Effect analysis of anterior serserus plane block and intercostal nerve block under intravenous general anesthesia combined with ultrasound guidance in thoracoscopic cuneform resection of lung. Prog Mod Biomed, 2023, 23(14): 2677-2682.
6. Madabushi R, Tewari S, Gautam SK, et al. Serratus anterior plane block: A new analgesic technique for post-thoracotomy pain. Pain Physician, 2015, 18(3): E421-E424.
7. 許晴雯, 占樂云, 馬會芹. 超聲引導下區域阻滯在胸科手術后鎮痛的臨床應用進展. 麻醉安全與質控, 2018, 2(6): 5.Xu QW, Zhan LY, Ma HQ. Clinical application of ultrasound-guided regional block for analgesia of thoracic surgery. Periop Safe Qual Assur, 2018, 2(6): 5.
8. 馬培奇. 美 FDA 批準布比卡因脂質體注射用懸浮液 Exparel 治療術后疼痛. 上海醫藥, 2012, 33(15): 29.Ma PQ. FDA approves bupivacaine liposome injection suspension Exparel for the treatment of postoperative pain. Shanghai Med Pharmaceutic J, 2012, 33(15): 29.
9. Jasper AO, Onohwakpor EA, Akhator A. High-risk surgeries, anesthetic challenges, and real benefits of peripheral regional techniques revisited. Niger J Clin Pract, 2021, 24(5): 782-785.
10. Echeverria-Villalobos M, Stoicea N, Todeschini AB, et al. Enhanced recovery after surgery (ERAS): A perspective review of postoperative pain management under ERAS pathways and its role on opioid crisis in United States. Clin J Pain, 2019, 36(3): 1.
11. Zhen SQ, Jin M, Chen YX, et al. Ultrasound-guided paravertebral nerve block anesthesia on the stress response and hemodynamics among lung cancer patients. World J Clin Cases, 2022, 10(7): 2174-2183.
12. Peter V, SylviaD A, Loay M , et al. Management of a parenteral opioid shortage using ASHP guidelines. A Am J Health Syst Pharm, 2021, 78(5): 426-435.
13. 張黃麗, 殷昌生, 賈曉姝, 等. 布比卡因脂質體術后鎮痛應用進展. 武警醫學, 2023, 34(6): 530-534.Zhang HL, Yin CS, Jia XS, et al. Progress in postoperative analgesia with bupivacaine liposome. Med J Chin People's Arm, 2023, 34(6): 530-534.
14. Sun L, Mu J, Gao B, et al. Comparison of the efficacy of ultrasound-guided erector spinae plane block and thoracic paravertebral block combined with intercostal nerve block for pain management in video-assisted thoracoscopic surgery: A prospective, randomized, controlled clinical trial. BMC Anesthesiol, 2022, 22(1): 283.
15. Li S, Feng J, Fan K, et al. The effect of ultrasound-guided intercostal nerve block on postoperative analgesia in thoracoscopic surgery: A randomized, double-blinded, clinical trial. J Cardiothorac Surg, 2023, 18(1): 128.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effectiveness of intercostal nerve block and analgesia with bupivacaine liposomes in single-port thoracoscopic lung surgery: A prospective study

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