Effect of Thoracic Paravertebral Block on Postoperative Pulmonary Complications After Video-Assisted Thoracoscopic Surgery: A Dual-Center Randomized Clinical Trial.

IF 2.8 3区 医学 Q1 Pharmacology, Toxicology and Pharmaceutics
Therapeutics and Clinical Risk Management Pub Date : 2025-05-15 eCollection Date: 2025-01-01 DOI:10.2147/TCRM.S515093
Jiayu Zhu, Biyu Wei, Lili Wu, He Li, Yi Zhang, Jinfeng Lu, Shaofei Su, Chunhua Xi, Wei Liu, Guyan Wang
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Abstract

Purpose: TPVB can provide effective postoperative analgesia in lung cancer patients undergoing video-assisted thoracoscopic surgery (VATS), which may enhance respiratory mechanics and postoperative expectoration, as well as relieve inflammation and stress. These mechanisms may reduce the incidence of postoperative pulmonary complications (PPCs). This study explored whether TPVB reduces the risk of PPCs in patients undergoing VATS for lung cancer.

Patients and methods: In this dual-center trial, patients who underwent VATS for lung cancer were randomly divided into the PV group (n = 151, general anesthesia [GA] and TPVB) and the C group (n = 151, GA only). The primary outcome was the incidence of a composite of PPCs within seven days postoperatively.

Results: The incidence of PPCs within seven days postoperatively was lower in the PV group (37.7%, 57/151) compared to the C group (49.0%, 74/151), with a risk ratio of 1.59 (95% CI: 1.00 to 2.50, P=0.048). And within 8-30 days postoperatively, compared with that in the C group (33.1%, 50/151), the incidence of PPCs was lower in patients in the PV group (22.5%, 34/151), with a risk ratio of 1.70 (95% CI, 1.02 to 2.84, P=0.040). There was a significant difference in the incidence of pneumonia between the PV group (11/151, 7.3%) and the C group (35/151, 23.3%; P < 0.001), and the incidence of pneumothorax between the PV group (27/151, 17.9%) and the C group (45/151, 29.8%; P = 0.015).

Conclusion: Compared to GA alone, TPVB combined with GA reduces the incidence of PPCs within seven days postoperatively in patients undergoing VATS for lung cancer, and this beneficial effect can last up to 30 days after surgery. A possible mechanism is that TPVB reduces acute postoperative pain in patients.

Abstract Image

Abstract Image

胸椎旁阻滞对电视胸腔镜术后肺部并发症的影响:一项双中心随机临床试验。
目的:TPVB可为肺癌胸腔镜手术(VATS)患者提供有效的术后镇痛,改善呼吸力学和术后排痰,缓解炎症和应激。这些机制可以减少术后肺部并发症(PPCs)的发生率。本研究探讨了TPVB是否能降低肺癌VATS患者发生PPCs的风险。患者和方法:在本双中心试验中,接受VATS治疗的肺癌患者随机分为PV组(n = 151,全麻[GA] + TPVB)和C组(n = 151,仅GA)。主要观察指标是术后7天内PPCs综合发生率。结果:PV组术后7 d内PPCs发生率(37.7%,57/151)低于C组(49.0%,74/151),风险比为1.59 (95% CI: 1.00 ~ 2.50, P=0.048)。在术后8 ~ 30天内,PV组患者PPCs发生率较C组(33.1%,50/151)低(22.5%,34/151),风险比为1.70 (95% CI, 1.02 ~ 2.84, P=0.040)。PV组肺炎发生率(11/151,7.3%)与C组(35/151,23.3%)比较差异有统计学意义;P < 0.001), PV组气胸发生率(27/151,17.9%)与C组气胸发生率(45/151,29.8%);P = 0.015)。结论:与GA单独使用相比,TPVB联合GA可降低肺癌VATS患者术后7天内PPCs的发生率,且这种有益效果可持续至术后30天。一个可能的机制是TPVB减轻了患者术后急性疼痛。
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来源期刊
Therapeutics and Clinical Risk Management
Therapeutics and Clinical Risk Management HEALTH CARE SCIENCES & SERVICES-
CiteScore
5.30
自引率
3.60%
发文量
139
审稿时长
16 weeks
期刊介绍: Therapeutics and Clinical Risk Management is an international, peer-reviewed journal of clinical therapeutics and risk management, focusing on concise rapid reporting of clinical studies in all therapeutic areas, outcomes, safety, and programs for the effective, safe, and sustained use of medicines, therapeutic and surgical interventions in all clinical areas. The journal welcomes submissions covering original research, clinical and epidemiological studies, reviews, guidelines, expert opinion and commentary. The journal will consider case reports but only if they make a valuable and original contribution to the literature. As of 18th March 2019, Therapeutics and Clinical Risk Management will no longer consider meta-analyses for publication. The journal does not accept study protocols, animal-based or cell line-based studies.
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