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.	刘飞, 张静, 张欢楷, 等. 超声引导胸椎旁阻滞治疗胸腔镜手术后早期中重度急性疼痛的疗效观察. 中华医学杂志, 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.	宗华, 高云飞, 哈斯艳·图尔逊, 等. 基于ERAS模式下探讨竖脊肌与神经阻滞麻醉对VATS手术患者镇痛、细胞因子及并发症的影响. 新疆医科大学学报, 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. 静脉全麻联合超声引导下前锯肌平面+肋间神经阻滞应用于胸腔镜肺楔形切除术效果分析. 现代生物医学进展, 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.	许晴雯, 占乐云, 马会芹. 超声引导下区域阻滞在胸科手术后镇痛的临床应用进展. 麻醉安全与质控, 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.	马培奇. 美 FDA 批准布比卡因脂质体注射用悬浮液 Exparel 治疗术后疼痛. 上海医药, 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.	张黄丽, 殷昌生, 贾晓姝, 等. 布比卡因脂质体术后镇痛应用进展. 武警医学, 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. 刘飞, 张静, 张欢楷, 等. 超声引导胸椎旁阻滞治疗胸腔镜手术后早期中重度急性疼痛的疗效观察. 中华医学杂志, 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. 宗华, 高云飞, 哈斯艳·图尔逊, 等. 基于ERAS模式下探讨竖脊肌与神经阻滞麻醉对VATS手术患者镇痛、细胞因子及并发症的影响. 新疆医科大学学报, 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. 静脉全麻联合超声引导下前锯肌平面+肋间神经阻滞应用于胸腔镜肺楔形切除术效果分析. 现代生物医学进展, 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. 许晴雯, 占乐云, 马会芹. 超声引导下区域阻滞在胸科手术后镇痛的临床应用进展. 麻醉安全与质控, 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. 马培奇. 美 FDA 批准布比卡因脂质体注射用悬浮液 Exparel 治疗术后疼痛. 上海医药, 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. 张黄丽, 殷昌生, 贾晓姝, 等. 布比卡因脂质体术后镇痛应用进展. 武警医学, 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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