超声引导下连续胸椎旁阻滞提高开腹肝切除术后患者的恢复质量：一项随机、双盲、安慰剂对照试验

doi:10.24920/003934

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Ultrasound-guided continuous thoracic paravertebral block (CTPVB) can provide pain-relieving and opioid-sparing effects in patients receiving open hepatectomy. However, the impact of this analgesic technique on quality of life (QoL) after open hepatectomy has not yet been evaluated. In this prospective, randomized, double-blind, placebo-controlled study, the authors assessed patients’ perception of recovery following open hepatectomy with CTPVB using the validated Chinese 15-item QoR (QoR-15C) questionnaire. It was found that perioperative CTPVB enhanced the QoR in patients undergoing open hepatectomy. In addition, this technique provided significant analgesia in the early postoperative period and also had an opioid-sparing effect.

Abstract

Background Ultrasound-guided continuous thoracic paravertebral block can provide pain-relieving and opioid-sparing effects in patients receiving open hepatectomy. We hypothesize that these effects may improve the quality of recovery (QoR) after open hepatectomy.
Methods Seventy-six patients undergoing open hepatectomy were randomized to receive a continuous thoracic paravertebral block with ropivacaine (CTPVB group) or normal saline (control group). All patients received patient-controlled intravenous analgesia with morphine postoperatively for 48 hours. The primary outcome was the global Chinese 15-item Quality of Recovery score on postoperative day 7, which was statistically analyzed using Student’s t-test.
Results Thirty-six patients in the CTPVB group and 37 in the control group completed the study. Compared to the control group, the CTPVB group had significantly increased global Chinese 15-item Quality of Recovery scores (133.14 ± 12.97 vs. 122.62 ± 14.89, P = 0.002) on postoperative day 7. Postoperative pain scores and cumulative morphine consumption were significantly lower for up to 8 and 48 hours (P < 0.05; P = 0.002), respectively, in the CTPVB group.
Conclusion Perioperative CTPVB markably promotes patient’s QoR after open hepatectomy with a profound analgesic effect in the early postoperative period.

Key words: thoracic paravertebral block, hepatectomy, quality of recovery, ropivacaine

Xulei Cui, Nan Xu, Zhiyong Zhang, Bo Zhu, Yuelun Zhang, Yongchang Zheng, Shunda Du, Yilei Mao, Xinting Sang, Yuguang Huang. Ultrasound-Guided Continuous Thoracic Paravertebral Block Improves Patientʼs Quality of Recovery After Open Hepatectomy: A Randomized, Double-Blind, Placebo-Controlled Trial[J].Chinese Medical Sciences Journal, 2022, 37(1): 15-22.

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Characteristics	Control (n=37)	CTPVB (n=36)	Statistics	P value
Age (yr), mean ± SD	57.08 ± 9.96	55.36 ± 11.20	0.694	0.490
Male/female (n)	22/15	22/14	0.210	0.538
Body weight (kg), mean ± SD	64.16 ± 9.53	65.54 ± 8.62	-0.648	0.519
BMI(kg/m²), mean ± SD	23.31 ± 3.15	23.56 ± 3.59	-0.009	0.850
ASA PS I/II/III (n)	13/23/1	18/17/1	0.014	0.907
Educational background < University^†/≥ university^‡ (n)	23/14	24/12	0.161	0.808
History of previous surgery, yes/no (n)	20/17	17/19	0.341	0.642
Medical insurance, yes/no (n)	32/5	33/3	0.502	0.711
SF-36 PCS scores, mean ± SD	45.75 ± 9.52	48.24 ± 9.70	-1.119	0.218
SF-36 MCS scores, mean ± SD	48.01 ± 9.94	49.94± 7.76	-0.925	0.334
Preoperative pain NRS score, median (IQR)	0 (0 to 1.5)	0 (0 to 1.75)	716.0	0.761
Duration of surgery (h), mean ± SD	3.00 ± 1.09	2.87 ± 0.91	0.297	0.578

Variables	Control group (n=37)	CTPVB group (n=36)	Statistics	P value
Pain scores at rest (NRS), median (IQR)
8 h postoperatively	3 (2 - 4)	2 (0.25 - 3)	437.5	<0.01
24 h postoperatively	2 (1.5 - 3)	2 (1 - 3)	581.0	0.332
48 h postoperatively	1 (0 - 2)	1 (0 - 2)	617.5	0.577
Pain scores with activity (NRS), median (IQR)
8 h postoperatively	4 (3 - 5)	3 (2 - 4)	442.5	<0.05
24 h postoperatively	4 (3 - 5)	3.5 (2 - 5)	615.5	0.571
48 h postoperatively	3 (2 - 4)	2 (2 - 3)	508.5	0.073
Cumulative morphine consumption(mg), median (IQR)
8 h postoperatively	7.50 (6.00 - 16.25)	4.50 (1.63 - 7.38)	308.0	<0.001
24 h postoperatively	19.50 (10.50 - 31.50)	10.25 (4.63 - 18.00)	346.5	<0.001
48 h postoperatively	26.00 (18.25 - 46.25)	17.25 (6.50 - 28.50)	381.0	<0.01
Episodes of PONV within 48 h, n (%)	23 (62.2)	16 (44.4)	2.302	0.129
Time to first out-of-bed activity (h), mean ± SD	56.15 ± 33.50	50.06 ± 22.56	0.909	0.367
Time to resumption of bowel movement (h), mean ± SD	54.23 ± 22.82	57.70 ± 28.29	-0.578	0.565
Length of postoperative stay (days), mean ± SD	9.56 ± 4.20	8.00 ± 2.26	1.979	0.052

[1]	Zhu Weihua,Xie Wenyong,Zhang Zhedong,Li Shu,Zhang Dafang,Liu Yijun,Zhu Jiye,Leng Xisheng. Postoperative Complications and Survival Analysis of Surgical Resection for Hilar Cholangiocarcinoma: A Retrospective Study of Fifty-Nine Consecutive Patients [J]. Chinese Medical Sciences Journal, 2020, 35(2): 157-169.
[2]	Che Lu, Lu Xin, Pei Li-jian. Efficacy and Safety of a Continuous Wound Catheter in Open Abdominal Partial Hepatectomy [J]. Chinese Medical Sciences Journal, 2017, 32(3): 171-176.

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