| 1.Objective:Based on establishment of animal model of non-intubated anesthesia with spontaneous ventilation for rabbits,we build the ideal model of paravertebral nerve block and intercostal nerve block,and then assess the above model of paravertebral nerve block.In various aspects such as pathology,ultrastructure and molecular biology,we understand the effect of paravertebral nerve block on inflammatory response in operation under non-intubated anesthesia with spontaneious ventilation.In the meanwhile,we compare with the advantage of postoperative pain control for paravertebral nerve block in video-assisted thoracoscopic surgery under non-intubated anesthesia.The third part of this study compares with differences of the stress response,inflammatory response and hemodynamics during the operation and effects of paravertebral nerve block on postoperative pain control and safety and chronic pain after the operation for the two groups.The fourth part of this study demonstrates the clinical value of paravertebral nerve block for patients undergoing operation with tuberculous empyema.2.Methods:(1)object of studyThe first part of this study is the same as the second part for study object including 36 of rabbits divided randomly paravertebral nerve block group and intercostal nerve block group by using the SPSS software.Based on the significant level,power,difference of the two groups and overall difference,the third part of this study is enrollment of 40 cases of patients with benign solitary pulmonary nodules undergoing the operation divided randomly the paravertebral nerve block group and intercostal nerve block group bu using the SPSS software.The fourth part of this study was observational study for the patients with tuberculous empyema for the study factor of paravertebral nerve block,whether or not paravertebral nerve block for the object of study was divided into the two groups including the experimental group was performed by paravertebral nerve block and the control group was performed by the same amount of normal saline.(2)Establishment and assessment of animal modelAnimal model of paravertebral nerve block was assessted by using magnetic resonance imaging and then ideal model can be screened.(3)Experimental methods:The first part of this study was established animal models of paravertebral nerve block and intercostal nerve block.The two groups of animal model were drawed blood for detection of inflammatory cytokines such as IL-6 and TNF-α at the different time points and then the operated lung tissue was biopsy.The plasma and bronchoalveolar lavage fluid of the animal model were saved at the environment of-80 degree centigrade.The second part of this study was established animal models of paravertebral nerve block and intercostal nerve block.After waken up for the rabbits,the targeted intercostal nerve function and the concentration of catecholamine were detected for the purpose of the effect of pain control.(4)Experimental detection The doctor was that who was ability to work independently,another doctor was recorded who was not doing this study.The purpose of the first part of this study was to realize the pathology and ultramicroscopic morphology of the two animal models of paravertebral nerve block and intercostal nerve block.The changes of the concentrations of TNF-α and IL-6 in the venous blood and bronchoalveolar lavage fluid were detected by using the methods of enzyme-linked immuno sorbent assay and reverse transcription-polymerase chain reaction.The third part of this study was to measure the concentrations of cortisol,IL-6 and TNF-a and compare with the changes of mechanical withdrawal threshold and the difference of the first time of pain feedback after the operation and consumption amount of morphine after the operation of 48 hours.We recorded the segments of block at 30 mins after the block and 6 hours after the operation and incidence of side effects in the two groups of paravertebral nerve block and intercostal nerve block.At last,we surveyed effects of chronic pain on quality of life in the two groups.The purpose of the fourth part of this study was to compare with difference of visual analogue scale at rest and ambulation after the operation in the two groups of paravertebral nerve block and intercostal nerve block.3.Results:(1)In the first part of this study,we can see that paravertebral nerve block group had a less degree of pulmonary inflammation in pathology at 4 hours than that of intercostal nerve block.However,the group of intercostal nerve block had a higher degree in the ultrastructure than that of paravertebral nerve block group.The result of enzyme-linked immuno sorbent assay was that the concentrations of TNF-α and IL-6 in the intercostal nerve block group in the serum or bronchoalveolar lavage fluid at 2hours or 4 hours had a higher degree than that of paravertebral nerve block group.In the meanwhile,the result of polymerase chain reaction was that the concentrations of TNF-α and IL-6 in the intercostal nerve block group in the plasma or bronchoalveolar lavage fluid at 4 hours had a higher degree than that of paravertebral nerve block group.(2)In the second part of this study,there was statistically significant difference in the group of nerve conductive velocity and incubation and another group of epinephrine and noradrenaline in the two animal model.(3)In the third part of this study,the concentration of IL-6 in the paravertebral nerve block group had a less degree than that of intercostal nerve block group at T2-3,in the meanwhile,the concentration of TNF-α in the paravertebral nerve block group had a less degree than that of intercostal nerve block group at T3.The concentration of cortisol in the paravertebral nerve block had a less degree than that of intercostal nerve block at T2-3.At 4 hours or 8 hours after the operation,the result of mechanical withdrawal threshold had a higher degree than that of intercostal nerve block group.Compared with the intercostal nerve block group,the first time of pain feedback had longer time in the paravertebral nerve block group after the operation,however,the consumption amount of morphine in the paravertebral nerve block group had less during the 48 hours after the operation.The blocked segments in the paravertebral nerve block group had bigger than that of intercostal nerve block group at both TA and TB.The patient as surveyed when it was at the time of the most severe pain,The incidences of the moderate pain and severe pain in the paravertebral nerve block group had less than that of intercostal nerve block group.(4)The fourth part of this study was that visual analogue scale at rest and ambulation in the experimental group had smaller score than that of control group at 1 hours,4 hours,8hours,12hours after the operation.In the meanwhile,visual analogue scale at rest in the experimental group had smaller score than that of control group at 24 hours after the operation.4.Conclusion:(1)Guidance of ultrasound and nerve stimulator can be established the ideal animal model of paravertebral nerve block and intercostal nerve block.The inflammatory response of paravertebral nerve block in the operation under non-intubated anesthesia had less degree than that of intercostal nerve block.It was evident advantage that paravertebral nerve block for postoperative pain control under non-intubated anesthesia with spontaneous ventilation.(2)Paravertebral nerve block of regional analgesia under non-intubated anesthesia could inhibit the inflammatory response,stress response and maintain hemodynamics during the operation for the purpose of enhanced recovery after surgery and have a better sensory block and a low incidence of complications after the operation and decrease the incidence of chronic pain after the surgery.(3)paravertebral nerve block of regional analgesia can promote the effect of postoperative pain control for patients with tuberculous empyema in order to enhance recovery after surgery. |
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