The Influence Of Ultrasuond-guided Paravertebral Nerve Block Combined With Propofol Sadation By Colsed-loop TCI On Patients Undergo Video-assisted Thoracos-copic Surgery

Objective:To investigate the Application of ultrasound-guided paravertebral nerve block combined with propofol sadation by colsed-loop TCI in the ERAS of patients undergo VATS lobectomy.Methods:eighty patients,ASA physicalⅠorⅡ,who were scheduled to undergo video-assisted thoracoscopic surgery were errolled in the study,and randomized into four group:group A（combined ultrasuond-guided paravertebral nerve block with propofol sadation by colsed-loop TCI）,group B（propofol sadation by colsed-loop TCI）,group C（ultrasuond-guided paravertebral nerve block with propofol sadation by TCI）,group D（propofol sadation by TCI）.Following data were collected:consumption of propofol and remifentanil during surgery;extubation time,hospital stays and Total hospital-ization expenses;static and dynamic VAS pain scores at 4h（T₃）,8h（T₄）,12h（T₅）,24h（T₆）and 48h（T₇）after surgery.Serum IL-6 and IL-10 concentrations were measured before anesthesia（T1）,end of operation（T₂）,24h after surgery（T₆）and 48h after surgery（T₇）.Results:1.The consumption of propofol and remifentanil:Compared with group A,the mean total consumption of propofol was significantly increased in group B,C and D（P（27）0.05）;the mean consumption of remifentanil was significantly increased in group B and D（P（27）0.05）,while was not significantly increased in group C（P（29）0.05）.2.The extubation time and hospital stays:Compared with group A,the mean total consumption of propofol was significantly increased in group B,C and D（P（27）0.05）;the mean consumption of remifentanil was significantly increased in group Band D（P（27）0.05）,while was not significantly increased in group C（P（29）0.05）.3.The static and dynamic VAS pain scores:The static and dynamic VAS pain scores atT3-T7 were not significant different between group A and group C and betweengroup B and group D（P（29）0.05）,the static and dynamic VAS pain scores at T3-T7 after surgery in group A,C were significantly lower than group B,D（P（27）0.05）.4.The serum IL-6 and IL-10 level from Internal jugular vein blood:Compared with T1,the serum IL-6 and IL-10 level in four group was significantly higher at T2,T6,T7（P（27）0.05）;Compared with group A,the serum IL-6 level atT2,T6 and T7were significantly higher in group B and D（P（27）0.05）,however,were not significantly higher in group C;the serum IL-10 level at T2,T6 and T7 were significantly lower in group B and C,however,were not significantly lower in group C（P（27）0.05）.Conclusion:Ultrasuond-guided paravertebral nerve block combined with propofol sadation by colsed-loop TCI can expediting postoperative rehabilitation of patients undergo video-assisted thoracoscopic surgery,and can acheieve a better anesthetic effect than a single application.