Discussion
thoracic paravertebral block, postoperative pain, ESPB, postoperative pulmonary infection, post-thoracotomy pain, fracture, injury of intercostal nerves, PVB, nausea and vomiting, pain, nerve lesions, hypotension, hematoma
NERVE LESION, HEMATOMA
In this study, we explored the effect of ultrasound-guided intercostal nerve block on postoperative analgesia in thoracoscopic surgery. Whatever in ICNB group or control group, none of patients had severe pain (VAS>6). The results indicate that multimodal analgesia [In this study, ICNB was used as an advance analgesic strategy to relieve thoracoscopic postoperative pain. Our results showed that ICNB could alleviate pain in the early stage after thoracoscopic surgery, reduce the VAS pain scores within 48 h after the surgery. With the multimodal analgesia used in the control group, about 30% of patients still needed rescue analgesia. In ICNB group, the incidence of rescue analgesia was reduced to 9.8%. Severe acute pain after thoracoscopic surgery is mainly due to the fracture or retraction of ribs and injury of intercostal nerves. ICNB can directly interrupts the flow of afferent pain signals through intercostal nerve and reduce pain intensity [Regional anesthesia techniques which used in thoracoscopic surgery include thoracic epidural analgesia (TEA), thoracic paravertebral block (PVB), erector spinae plane block (ESPB) and ICNB. TEA was once considered as the gold standard for post-thoracotomy pain management, but it is associated with high potential risks of dural puncture, nerve lesions, peidural hematoma and hypotension [The duration of insertion of chest tube and postoperative pulmonary infection rate were lower than those in the control group. The reason was that the patients could act the respiratory function better under the good analgesic effect.Good postoperative pain management can provide conditions for patients to perform respiratory function training, so our study showed the less duration of insertion of chest tube and less incidence of postoperative pulmonary infection. Also, it could decrease the incidence of nausea and vomiting which caused by opioid analgesics [Our study has some limitations. First, we evaluated the VAS for pain at rest but not while coughing. The VAS is generally higher when coughing than at rest. A more comprehensive assessment of the postoperative pain might provide more useful findings. Second, we chose the VAS scores as the analysis index, The VAS score is a subjective indicator rather than an objective indicator. We should combine some objective indicators to evaluate in the further study. Third, this study may strongly depend on the anesthesiologist’s or surgeon’s experience. Fourth, the study failed to count opioid use. Thus, more objective evaluation indicators can be sought in subsequent studies, and pain management can be individualized for patients.