A comparison of the incidence of supraventricular arrhythmias between thoracic paravertebral and intercostal nerve blocks in patients undergoing thoracoscopic surgery: A randomised trial

摘要

BACKGROUNDPostoperative supraventricular arrhythmias are common in patients after thoracoscopic lobectomy. Inadequate pain control has long been recognised as a significant risk factor for arrhythmias. The performance of ultrasound-guided (USG) thoracic paravertebral block (PVB) is increasing as an ideal technique for postoperative analgesia.OBJECTIVEWe conducted this study to evaluate whether a single-shot USG thoracic PVB would result in fewer postoperative supraventricular tachycardias (SVT) than intercostal nerve blocks (ICNBs) after thoracoscopic pulmonary resection.DESIGNA randomised controlled study.SETTINGA single university hospital.PATIENTSSixty-eight patients undergoing thoracoscopic lobectomy were randomised into two equal groups of 34.INTERVENTIONSFor postoperative pain control, all patients received a total of 0.3mlkg(-1) of a mixture containing 0.5% ropivacaine and 1/200000 epinephrine after placement of needles for either a single thoracic PVB or two individual ICNBs, both guided by ultrasound. Data were obtained during the first 48 postoperative hours.MAIN OUTCOME MEASURESThe primary outcome was the incidence of SVT after thoracoscopic pulmonary resection.RESULTSDuring the first 48 postoperative hours, the incidences of SVT and atrial fibrillation were lower in the USG thoracic PVB group (14.7 vs. 46.9%, P=0.004 and 3.0 vs. 18.8%, P=0.037, respectively). The requirement for -receptor blockade was more frequent in the ICNBs group than in the PVB group (5.9 vs. 25%, P=0.033).CONCLUSIONAfter placement of the needle using ultrasound guidance, a single-shot thoracic PVB is a well tolerated and effective technique to reduce the incidences of postoperative SVT and atrial fibrillation in patients undergoing thoracoscopic pulmonary resection.TRIAL REGISTRATIONhttp://www.chictr.org/cn/, registration number: ChiCTR-IOR-17010952.