Effect Of Different Analgesic Methods On Postoperative Pain And Stress Response In Patients Undergoing Uniportal Thoracoscopic Surgery

Objective To compare the effects of different multimodal analgesic methods on postoperative acute pain and stress in patients undergoing uniportal video-assisted thoracic surgery.Method A total of 110 patients who underwent selective uniportal video-assisted thoracic surgery from October 2018 to February 2019 were randomly divided into the control group and the experimental group.Control group:patient-controlled intravenous analgesia group（P group）.Experimental group:single paravertebral block combined with patient-controlled intravenous analgesia（TP group）,single spinal erector block combined with patient-controlled intravenous analgesia（EP group）,single spinal erector block combined with single paravertebral block combined with patient-controlled intravenous analgesia（ETP group）.The operative time of the selected patients was 8.30am to 12.00am every day.Patients entered the operating room at 7:50,established venous access after entering the room,and underwent ecg monitoring.5ml of peripheral venous blood was extracted before nerve block operation（T₁）at 8:00,and sent for examination.Patients in the experimental group completed nerve block under ultrasound guidance at 8:10.Routine general anesthesia was performed in group P,and all patients were transferred to anaesthesia post anesthesia care unit for monitoring and anaesthesia resuscitation after the operation.Patients in the four groups were eligible for combined analgesia using PCIA and intravenous non-steroidal anti-inflammatory drugs（nsaid）.Meanwhile,5ml of peripheral venous blood was extracted at 30min（T₂）after the operation,30min（T₃）after the tracheal extubation,and 24h（T₄）after the operation,respectively,to detect the concentrations of cortisol（Cor）and ACTH（ACTH）in serum.Four groups of patients who adopt a unified anesthesia to maintain solution,record the patient home after resting state（T₅）,15 min after the nerve block（T₆）,surgery cut skin instantly（T₇ has）,30 min after the start of operation（T₈）,tracheal extubation after 5 min（T₉）MAP and HR,records of the usage of norepinephrine and the total dosage of remifentanil.Postoperative 15min（0h）,6h,12h,24h and 48h,the patients were assessed for pain during rest and cough according to VAS,and the PCIA compression times,the total amount of PCIA sufentanil,and the use of analgesics in the postoperative ward were recorded.Patients’satisfaction with postoperative analgesia was evaluated.Nerve block plane（number of blocks）,postoperative analgesia adverse reactions.Results A total of 100 patients,25 in each group,completed the postoperative follow-up study.（1）VAS scores of resting and coughing status within 12h after surgery in TP group,EP group and ETP group were significantly lower than those in P group,and intraoperative total amount of remifentanil,analgesic pump compressions,and total PCIA infusion were significantly lower than those in P group,with statistically significant differences（P<0.05）.Postoperative adverse reactions,such as nausea and vomiting,were low,and analgesic effect satisfaction was high.VAS scores of resting and coughing state in the TP group and ETP group were significantly lower than those in the EP group at15min（0h）after tracheal extubation,and the difference was statistically significant（P<0.05）.There were more cases of PACU in P group and EP group than in TP group and ETP group.（2）comparison of stress hormones:there was no significant difference in the plasma concentrations of Cor and ACTH at T1 between the four groups（P>0.05）.The plasma concentrations of Cor and ACTH at T2 and T3 in TP group and EP group were lower than those in P group,and the difference was statistically significant（P<0.05）.There was no significant difference between TP group,EP group and ETP group in Cor and ACTH plasma concentrations at T2,T3 and T4（P>0.05）.In the TP,EP and ETP groups,the plasma concentrations of Cor and ACTH at T2and T3 were lower than those at T1,and the difference was statistically significant（P<0.05）.（3）comparison of MAP and HR:intra-group comparison showed that MAP and HR at time T9 in group P were significantly higher than those at time T5,and the difference was statistically significant（P<0.05）.MAP and HR of T6,T8 and T9 in the TP group were significantly lower than those at T5,with statistically significant differences（P<0.05）.There was no significant difference in MAP and HR between EP group and ETP group（P>0.05）.There was no significant difference in MAP and HR at T5,T6 and T7 between groups（P>0.05）.MAP and HR at T8 and T9 time in TP group were significantly lower than those in EP group and ETP group,and the difference was statistically significant（P<0.05）.（4）compared with the norepinephrine dosage in the four groups,the norepinephrine dosage in the TP group was significantly higher than that in the P group,the TP group and the ETP group,and the difference was statistically significant（P<0.05）.（5）block planes（number of blocks）were measured by acupuncture.5min after nerve block,the number of blocks in EP group was higher than that in TP group,and the difference was statistically significant（P<0.05）.At 15min,the number of blocks in TP group and EP group and ETP group there was no statistically significant differences（P>0.05）.Conclusion （1）the analgesic effect of paravertebral block after single-port thoracoscopic surgery is equivalent to that of erector spinalis block+paravertebral block,and better than that of single erector spinalis block;Paravertebral block significantly inhibited intraoperative blood pressure and heart rate.（2）Three nerve block methods combined with PCIA multi-mode analgesia methods can significantly reduce the amount of opioids,reduce the incidence of postoperative nausea and vomiting,inhibit the stress response of patients undergoing uniportal video-assisted thoracic surgery,and improve patient satisfaction.