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A. 高雄醫學大學附設醫院麻醉部
T. 07-3121101 #7033、7035
F. 07-3217874
E. 2020annualmeetingtsa@gmail.com
許弘德 Hung-Te Hsu
許弘德Hung-Te Hsu

高雄醫學大學附設醫院麻醉部 主治醫師
高雄醫學大學麻醉學科 助理教授
台灣麻醉醫學會專科甄審委員會 委員
台灣心臟胸腔暨血管麻醉醫學會 副秘書長


高雄醫學大學附設醫院麻醉科 住院醫師
高雄醫學大學附設醫院麻醉科 主治醫師
高雄市立大同醫院麻醉科 主任
高雄醫學大學附設醫院麻醉部 主治醫師
高雄醫學大學麻醉學科 助理教授


胸腔外科手術後的疼痛通常十分嚴重,因為後外側開胸是最痛的手術切口之一。因此,如果手術後疼痛控制不當,患者在術後可能會因為疼痛而引起呼吸系統並發症,例如缺氧、肺塌陷和肺部感染。此外,不當的疼痛控制會導致開胸術後疼痛綜合症,這種綜合症可能很嚴重且難以處理並且會持續很多年。胸腔鏡手術 (VATS) 在目前是胸腔手術的主流。儘管與傳統開胸手術相比,VATS有著較少的肺部損傷和急性術後疼痛,但中度至重度的術後疼痛仍然可能存在,多達30%至50%的患者會經歷持續性疼痛。 而且在少數VATS患者中,由於手術因素,可能會在術中轉換為傳統開胸手術。
  因此對於胸腔手術來說,選擇合適的術後疼痛控制技術十分重要。傳統上,硬膜外止痛(EA)已成為傳統開胸手術的金標準。另一個選擇是使用胸椎旁阻滯(TPVB)。近年來,將肌筋膜平面阻滯術用於開放式腹胸手術的術後止痛也越來越受到大家的關注。豎脊肌平面阻滯 (ESPB) 就是這屬於這種止痛方式的新興技術。目前的研究表明,ESPB用於成人胸腔手術後,創傷後和慢性神經性胸痛可以作為一種簡單,安全的替代止痛技術。此外,超音波導引技術的介入也將提高胸廓局部神經阻滯術的成功率並降低併發症的發生率。

Application of Regional Anesthesia for Pain Relief in Thoracic Surgery
The pain after thoracic surgery is usually very severe, because the posterior lateral thoracotomy is one of the most painful surgical incisions. Therefore, if the pain is not properly controlled after the operation, the patient may cause respiratory complications such as hypoxia, actelectasis and lung infection. In addition,inadquate pain control can lead to post-thoracotomy pain syndrome, which can be serious, incapacitating, and may last for many years. Video-assisted thoracoscopic surgery (VATS) is currently the main stream of thoracic surgery. Although VATS has less lung damage and acute postoperative pain compared with traditional thoracotomy, moderate to severe postoperative pain may still exist, and as many as 30% to 50% of patients will experience persistent pain . Moreover, in a small number of VATS patients, due to surgical factors, it may be converted to traditional thoracotomy during the operation.
  Therefore, for thoracic surgery, it is very important to choose appropriate postoperative pain control techniques. Traditionally, epidural analgesia (EA) has become the gold standard for traditional thoracotomy. Another option is to use thoracic paravertebral block (TPVB). In recent years, the use of myofascial plane block for postoperative pain relief in open abdominal thoracic surgery has also attracted increasing attention. The erector spinal muscle plane block (ESPB) is an emerging technique that belongs to this type of pain relief. Current research shows that ESPB can be used as a simple and safe alternative pain relief technique for post-traumatic and chronic neuropathic chest pain after thoracic surgery in adults. In addition, the intervention of ultrasonic guide technology will also increase the success rate of thoracic local nerve block and reduce the incidence of complications.