关键词: 脉冲射频；肋间神经阻滞；胸腔镜手术；术后镇痛；恢复质量

Abstract: Objective To explore the effects of pulsed radiofrequency(PRF) intercostal nerve block on postoperative analgesia and recovery quality in patients undergoing thoracoscopic lung surgery.Method Ninety patients scheduled for unilateral thoracoscopic lung resection between July 2021 and July 2022 were enrolled and randomly divided into two groups,with 45 patients in each group:the intercostal nerve block with local anesthetics group(INB group) and the intercostal nerve block with PRF group(PRF group).Intercostal nerve blocks were performed under ultrasound guidance before general anesthesia in both groups, followed by patient-controlled intravenous analgesia(PCIA) postoperatively.Intraoperative mean arterial pressure(MAP), heart rate(HR), propofol and remifentanil consumption, incidence of hypertension and tachycardia during recovery, visual analog scale(VAS) scores at various time points after awakening, number of presses on the postoperative analgesia pump, cases requiring rescue analgesia, postoperative sufentanil and pethidine consumption, occurrence of postoperative adverse reactions, preoperative and postoperative QoR-40 scores, pain control, and nerve injury after discharge were observed and recorded.Results The incidence of hypertension and tachycardia during recovery in the PRF group were significantly lower than those in the INB group(P＜0.05).The resting VAS scores in the PRF group at awakening(T₄),2 hours post-awakening(T₅),6 hours post-awakening(T₆),24 hours post-awakening(T₇),and 48 hours post-awakening(T₈) were significantly lower than those in the INB group(P＜0.05).Both the number of presses on the analgesia pump and the number of cases requiring rescue analgesia in the PRF group were significantly lower than those in the INB group(P＜0.05).The postoperative consumption of sufentanil at 24 hours and 48 hours,and pethidine in the PRF group was significantly lower than that in the INB group(P＜0.05).The total QoR-40 scores on postoperative days 1,3,and 7 in the PRF group were significantly higher than those in the INB group(P＜0.05).The incidence of postoperative nausea and vomiting in the PRF group was 4.44%,which was significantly lower than that in the INB group(20%)(P＜0.05).The proportion of patients with mild pain in the PRF group was significantly lower than that in the INB group at 2 weeks,1 month,2 months,and 3 months postoperatively(P＜0.05).The proportion of patients with severe pain in the PRF group was significantly lower than that in the INB group at 2 months and 3 months postoperatively(P＜0.05).Conclusion PRF intercostal nerve block can effectively alleviate postoperative pain in thoracoscopic lung surgery,significantly improve postoperative recovery quality,and has a lower incidence of postoperative adverse reactions and complications.It is a safe and effective method for pain relief.

Key words: pulsed radiofrequency； intercostal nerve block； video-assisted thoracic surgery；postoperative analgesia； quality of recovery