Comparison Of Clinical Efficacy Of Ultrasound-guided Thoracic Paravertebral Nerve Block And Erector Spinae Plane Block For Thoracoscopic Lobectomy

Objective:In this study,we propose to compare the clinical efficacy of ultrasound-guided thoracic paravertebral nerve block(TPVB)and erector spinae plane block(ESPB)in thoracoscopic surgery(VATS)to explore a safe and effective analgesic method in the perioperative period of thoracic surgery.Methods:Fifty patients undergoing thoracoscopic lobectomy under general anesthesia from June 2019 to December 2019 in Shanxi Bethune Hospital were selected and randomly divided into T and E groups,with 25 patients in each group.Group T and Group E were treated with 20 ml 0.5% ropivacaine for TPVB and ESPB before general anesthesia induction.During the operation,propofol and sufentanil were pumped for anesthesia maintenance.Patient-controlled intravenous analgesia device(PCIA)with sufentanil was connected after the operation.Intraoperative sufentanil dosage,recovery time of spontaneous respiration,time of awakening(time from drug withdrawal to eye opening),and time of extubation(time from drug withdrawal to extubation)were recorded in the two groups.VAS scores at resting and coughing state at 1,6,8,12 and 24 h after surgery,the time of the first pressure on the analgesia pump,the effective pressure times of the analgesia pump within 48 h after surgery,the number of remedy cases of flurbiprofen axetil,and the occurrence of adverse reactions in 2 groups were recorded.Results:There were no significant differences in intraoperative sufentanil dosage,recovery time of spontaneous respiration,awakening time and extraction time of endotracheal tube between T group and E group(P>0.05).No significant difference was found in the VAS scores of the two groups at resting and coughing state 1,6 and 8h after surgery(P>0.05),and the VAS scores of group E at resting and coughing state at 12 and 24 h after surgery were significantly higher than those of group T(P<0.05).Compared with group T,the first press time of postoperative analgesia pump in group E was significantly earlier(P<0.05),and the number of analgesic pump presses and the dosage of flurbiprofen axetil within 48 h after operation were significantly increased(P<0.05).Postoperative respiratory depression and agitation were not observed in both groups,and the incidence of nausea and vomiting was significantly higher in group E than in group T(P<0.05).Conclusion:The analgesic effect of thoracic paravertebral nerve block under ultrasound guidance is better than erector spinal muscle plane block.The analgesia lasts for a long time,the operation under ultrasound guidance is simple and safe,and there are few adverse reactions.It is worth clinical recommendation.