围手术期输注利多卡因对胸镜下全肺切除术患者术后慢性疼痛的影响

围手术期输注利多卡因对胸镜下全肺切除术患者术后慢性疼痛的影响

贵州医科大学     麻醉与心脏电生理课题组

翻译：张中伟   编辑：张中伟  审核：曹莹

罂 粟 摘 要   

背景：接受胸腔镜下全肺切除术的患者术后慢性疼痛发生率较高。关于围手术期静脉输注利多卡因是否有益在有关胸腔镜下全肺切除术的研究中仍然存在争议。

方法：将64例肺癌患者随机分为两组：生理盐水组(对照组)和利多卡因组。利多卡因组在麻醉诱导期间静脉输注1.5 mg/kg利多卡因，并持续静脉滴注2 mg/kg/h利多卡因至手术结束。术后病人自控静脉镇痛泵持续静脉滴注舒芬太尼2μg/kg和利多卡因10 mg/kg。对照组在麻醉诱导、维持及术后病人自控静脉镇痛过程中，按利多卡因用量计算给予等体积生理盐水。主要观察结果是术后3个月内慢性疼痛的发生率。次要观察结果包括术后6个月内慢性疼痛发生率、术后24小时和48小时内利多卡因对术后疼痛的影响、整个手术过程中舒芬太尼的用量和术后48小时内的自控镇痛次数。

结果：利多卡因组术后3个月内慢性疼痛发生率明显低于对照组(13例，46.4% vs. 6例，20.7%，P<0.05)，6个月内两组间差异无统计学意义。利多卡因组围术期舒芬太尼累积用量(149.64±18.20μg)明显低于对照组(139.47±16.75μg)(P<0.0 5)，PCA触发次数(8.2 1±4.37)次明显低于对照组(5.83±4.12)次(P<0.0 5)。术后24 h(1.68±0.72比1.90±0.86)和48 h(1.21±0.42比1.20±0.41)NRS疼痛评分差异无统计学意义。

结论：围手术期输注利多卡因显著减少了胸腔镜下肺切除术后3个月的PCA触发次数和慢性疼痛的发生率。

原始文献来源：Yi Lu, Hehe Ding, Caiqun Shao, et al.Effect of lidocaine perioperative infusion on chronic postsurgical pain in patients undergoing thoracoscopic radical pneumonectomy.[J]. BMC Anesthesiol(2022) 22:255

英文原文   

Effect of lidocaine perioperative infusion on chronic postsurgical pain in patients undergoing thoracoscopic radical pneumonectomy

Abstract

Background: Thoracoscopic radical pneumonectomy is associated with a high incidence of postoperative chronic pain. Studies on the benefits of lidocaine intravenous infusion during the perioperative period were still controversial in thoracoscopic surgery.

Methods: Sixty-four lung cancer patients scheduled for thoracoscopic radical pneumonectomy were randomly divided into two groups: normal saline group (control group) or lidocaine group. In the lidocaine group, 1.5 mg/kg lidocaine was administered during the anesthesia induction, and 2 mg·kg−1·h−1 lidocaine was continuously intravenous infused until the end of the surgery. After the surgery, a mixture of 2 μg/kg sufentanil and 10 mg/kg lidocaine was continuously intravenous infused by postoperative patient-controlled intravenous analgesia pump (100 ml). In the control group, the same volume of normal saline was administered according to the calculation of lidocaine during anesthesia induction, maintenance and postoperative patient-controlled intravenous analgesia. The primary outcome was the incidence of chronic postoperative pain at 3 months after the surgery. The secondary outcomes include the incidence of chronic postoperative pain at 6 months after the surgery; the effect of lidocaine on postoperative pain within the first 24 and 48 h; total amount of sufentanil administered during entire procedure and the number of PCA triggers within 48 h after surgery.

Results: Compared with the control group, the incidence of chronic pain at 3 months after the surgery was significantly lower (13 cases, 46.4% vs. 6 cases, 20.7%, p < 0.05), but no significant difference at 6 months between two group. The cumulative dosage of sufentanil in perioperative period was significantly lower (149.64 ± 18.20 μg vs. 139.47 ± 16.75 μg) (p < 0.05), and the number of PCA triggers (8.21 ± 4.37 vs. 5.83 ± 4.12, p < 0.05) was significantly greater in the control group. The NRS pain scores at 24 h (1.68 ± 0.72 vs. 1.90 ± 0.86) and 48 h (1.21 ± 0.42 vs. 1.20 ± 0.41) after the operation were no significant difference.

Conclusion: Perioperative infusion lidocaine significantly reduced the number of PCA triggers and the incidence of chronic postoperative pain at 3 months after the thoracoscopic radical pneumonectomy.

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