Jiayu Zhu, Biyu Wei, Lili Wu, He Li, Yi Zhang, Jinfeng Lu, Shaofei Su, Chunhua Xi, Wei Liu, Guyan Wang
{"title":"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。","authors":"Jiayu Zhu, Biyu Wei, Lili Wu, He Li, Yi Zhang, Jinfeng Lu, Shaofei Su, Chunhua Xi, Wei Liu, Guyan Wang","doi":"10.2147/TCRM.S515093","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Patients and methods: </strong>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.</p><p><strong>Results: </strong>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, <i>P</i>=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, <i>P</i>=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%; <i>P</i> < 0.001), and the incidence of pneumothorax between the PV group (27/151, 17.9%) and the C group (45/151, 29.8%; <i>P</i> = 0.015).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"691-703"},"PeriodicalIF":2.8000,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12087603/pdf/","citationCount":"0","resultStr":"{\"title\":\"Effect of Thoracic Paravertebral Block on Postoperative Pulmonary Complications After Video-Assisted Thoracoscopic Surgery: A Dual-Center Randomized Clinical Trial.\",\"authors\":\"Jiayu Zhu, Biyu Wei, Lili Wu, He Li, Yi Zhang, Jinfeng Lu, Shaofei Su, Chunhua Xi, Wei Liu, Guyan Wang\",\"doi\":\"10.2147/TCRM.S515093\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>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.</p><p><strong>Patients and methods: </strong>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.</p><p><strong>Results: </strong>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, <i>P</i>=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, <i>P</i>=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%; <i>P</i> < 0.001), and the incidence of pneumothorax between the PV group (27/151, 17.9%) and the C group (45/151, 29.8%; <i>P</i> = 0.015).</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":22977,\"journal\":{\"name\":\"Therapeutics and Clinical Risk Management\",\"volume\":\"21 \",\"pages\":\"691-703\"},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2025-05-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12087603/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Therapeutics and Clinical Risk Management\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.2147/TCRM.S515093\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"Pharmacology, Toxicology and Pharmaceutics\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Therapeutics and Clinical Risk Management","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2147/TCRM.S515093","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"Pharmacology, Toxicology and Pharmaceutics","Score":null,"Total":0}
Effect of Thoracic Paravertebral Block on Postoperative Pulmonary Complications After Video-Assisted Thoracoscopic Surgery: A Dual-Center Randomized Clinical Trial.
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.
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.