Investigation Of Thoracic Paravertebral Nerve Block For Patients Following Video Assisted Thoracic Surgery Lobectomy

Objective: In recent years,with the development of minimally invasive surgery,video assisted thoracoscopic surgery(VATS)has gradually replaced the traditional thoracotomy.Although thoracic epidural anesthesia(TEA)has always been the "gold standard" for postoperative analgesia in thoracic surgery,its clinical application is limited to a certain extent due to the consideration of coagulation and the difficulty of operation.Thoracic paravertebral nerve block(TPVB)has attracted more and more attention because of its advantages such as stable circulation,high success rate of ultrasound assisted puncture and less adverse reactions.A large number of studies have shown that TPVB can provide postoperative analgesia similar to TEA,but the application of TPVB is different.Therefore,this study observed the analgesic effect and the incidence of complications of TPVB combined with patient-controlled intravenous analgesia pump and TEA analgesia.The purpose of this study is to provide a convenient,effective,safe and comfortable postoperative analgesia method for this kind of patients.Methods: 52 patients undergoing video assisted thoracic surgery(VATS)lobectomy were randomly divided into two groups : general anesthesia combined thoracic epidural group(group E,n=26)and general anesthesia combined thoracic paravertebral nerve block group(group P,n=26).Patients in group E: A thoracic epidural analgesia was performed before intubation and given an experimental dose of lidocaine hydrochloride.Intraoperative analgesia was maintained by general analgesia combined epidural analgesia.Patient control epidural analgesia(PCEA)was attached immediately after extubation.The PCEA regimen consisted of 0.125% ropivacaine 300 ml and was set to deliver a 5 ml bolus on demand,with a lock out interval of 40 min,and a back ground infusion rate of 5 ml/h.Patients in group P: A single level ultrasound guided thoracic paravertebral nerve block was performed before intubation.And given a 0.375% ropivacaine 15 mL.Intraoperative analgesia was maintained by general analgesia.Patient control intravenous analgesia(PCIA)was attached immediately after extubation.The PCIA regimen consisted of Dexmedetomidine 3.75 ug/kg,sufentanil 3.0 ug/kg and 24 mg ondansetron,mixed with 0.9% normal saline to a total volume of 150 ml.The PCA device was programmed to deliver a 2 mL/h background infusion and 2 mL on-demand bolus,with a 15-minute lockout time.Intraoperative fluid consumption,cumulative sufuntanil consumption,vasopressor consumption was recorded.The visual analog scale(VAS)score at deep breath and rest,Ramsey sedation scale(RSS),postoperative nausea and vomiting(PONV)times,side effects and overall patient satisfactory were measured at the time points of 6h(T1),12h(T2),24h(T3),36h(T4),48h(T5),72h(T6)after surgery during three days` follow up.Results: 1.The dynamic VAS scores of both groups are relatively high in the first 12 h postoperatively and there is significant difference between two groups.During 24 h to 72 h after surgery,the level of pain score is higher in group P however there was no significant difference between two groups.There was no statistically significant difference between two groups in the VAS score in all time points.For both of the group the lowest score was observed in 6h after surgery.2.Whereas the static VAS score in group P is always higher than that in Group E.3.There was significant differences(p=0.023)towards the level of sedation between the two Groups from 6h to 12 h postoperatively,Group P has the deeper RSS scores than Group E in all time points(Table 4).4.The incidence rates of PONV in group P and group E are 19.23% and7.69% respectively in all time points.However the incidence of dizziness is significantly high in group P.While,there was no other side effects happened in all patients.Conclusion: 1.The effect of thoracic paravertebral nerve block combined with patient controlled intravenous analgesia in patients following VATS lobectomy can provide the same level of postoperative analgesia as that of thoracic epidural anesthesia.2.The ultrasound guided paravertebral nerve block technique has the advantages of simple operation,low incidence of adverse events,few side effects and wide range of adaptation.3.The use of general anesthesia combined with thoracic paravertebral nerve block can play a preemptive analgesic effect,with little fluctuation of hemodynamic level,less volume of fluid infusion and less times of rescue analgesia.4.Compared with epidural analgesia,the incidence of nausea,vomiting and dizziness of intravenous analgesia combined with low dose sufentanil was higher than that of epidural analgesia.