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胸椎横突孔阻滞与胸椎旁阻滞在VATS肺切除术后镇痛效果比较：一项随机非劣效性试验
贵州医科大学 麻醉与电生理课题组
翻译：张中伟 编辑：杨荣峰 审校：曹莹
本研究评估了胸椎横突孔阻滞（CTFB）在视频辅助胸腔镜手术（VATS）中的肺切除术后镇痛效果方面是否不弱于胸椎旁阻滞（TPVB）。
本研究采用单中心、双盲、随机、非劣效性试验。纳入患者年龄在20至80岁之间，美国麻醉医师协会身体状况评分为1至3级，择期接受VATS肺切除术的患者。60例患者随机分配为1:1，分别接受CTFB或TPVB，使用15 mL的0.5%罗哌卡因，在全身麻醉诱导后立即在T4-5和T6-7肋间水平进行阻滞。主要结局是术后24小时内数字评分量表（NRS，0至10）曲线下面积（AUC）（非劣效性界限为24；每小时NRS 1）。次要结局包括术后阿片类药物消耗量、追加镇痛药物使用量、术后恶心呕吐、肺功能、阻滞的皮节分布和恢复质量。
47例患者纳入最终分析。CTFB组（34.25 ± 16.30，n = 24）和TPVB组（39.52 ± 17.13，n = 23）的NRS 24小时AUC均值之差为-5.27（95%置信区间[CI]，-15.09至4.55），其95%CI的上限远低于预先定义的非劣效性界限24。两组之间的阻滞皮节分布无显著差异，均达到最高和最低水平的T3和T7（中位数）。此外，两组之间其他次要结局也无显著差异。
CTFB在VATS肺切除术后24小时内的镇痛效果不逊于TPVB。此外，CTFB通过将针尖远离胸膜和血管结构，可能提供潜在的安全优势。
原始文献来源：Chahyun Oh, Yooyoung Chong, Min-Woong Kang,et al.Comparison between costotransverse foramen block and thoracic paravertebral block for VATS pulmonary resection: A randomized noninferiority trial [J]. (J Clin Anesth. 2023 Sep;88:111127).
英文原文
Comparison between costotransverse foramen block and thoracic paravertebral block for VATS pulmonary resection: A randomized noninferiority trial
Abstract
Study objective: The present study assessed whether costotransverse foramen block (CTFB) is noninferior to thoracic paravertebral block (TPVB) for postoperative analgesia in video-assisted thoracoscopic surgery (VATS) pulmonary resection.
Design: Single-center, double-blinded, randomized, non-inferiority trial.
Setting: Operating room and intensive care unit or ward in a tertiary hospital.
Patients: Patients aged 20 to 80 years with American Society of Anesthesiology physical status 1 to 3 scheduled for elective VATS pulmonary resection.
Interventions: Sixty patients were randomly allocated 1:1 to receive CTFB or TPVB using 15 mL aliquots of 0.5% ropivacaine at the T4–5 and T6–7 intercostal levels immediately after the induction of general anesthesia.
Measurements: The primary outcome was the area under the curve (AUC) of numeric rating scale (NRS, 0 to 10) during 24 h postoperatively (noninferiority limit was 24; NRS 1 per hour). The secondary outcomes included postoperative opioid consumption, rescue analgesic use, postoperative nausea and vomiting, pulmonary function, dermatomal spread of the blockade, and quality of recovery.
Main results: Forty-seven patients were included for final analysis. The difference between the mean 24-h AUCs of NRS in the CTFB (34.25 ± 16.30, n = 24) and TPVB (39.52 ± 17.13, n = 23) groups was -5.27 (95% confidence interval [CI], -15.09 to 4.55), with the upper limit of 95% CI being far below the predefined noninferiority margin of 24. There was no significant difference in the dermatomal spread of the blockades between the groups, as both reached the upper and lower most levels of T3 and T7 (median). Additionally, there were no significant differences in other secondary outcomes between the two groups.
Conclusions: The analgesic effect of CTFB was noninferior to that of TPVB during 24 h postoperatively in VATS pulmonary resection. Moreover, CTFB may offer potential safety benefits by keeping the tip of the needle far from the pleura and vascular structure.
