Comparison Of Ultrasound-guided Costotransverse Block And Thoracic Paravertebral Block For Thoracoscopic Radical Lung Cancer

Background: Cancer data released by the International Agency for Research on Cancer in 2020 showed that there were 2.2 million new cases of lung cancer,ranking second in cancer incidence.Non-small cell lung cancer usually requires surgery,and patients who undergo open-heart surgery often experience moderate to severe pain,are prone to respiratory complications such as pneumonia and water loss,have prolonged hospital stays and reduced quality of life,and some patients may even develop persistent pain syndrome.With the rapid development of lung resection technology,thoracoscopic lung surgery has been widely used in clinical practice,and many procedures are also performed using single-port thoracoscopy and robotic technology.Compared with open-heart surgery,thoracoscopic radical lung cancer surgery can improve respiratory function,reduce postoperative pain,decrease hospital stay,and is better tolerated.Although postoperative pain is reduced,moderate to severe pain can often be achieved after radical thoracoscopic lung cancer surgery.Thoracic paravertebral blocks were introduced in 1979 for thoracic analgesia and are now widely used for thoracic analgesia.In this study,we evaluated the effectiveness of a transverse rib block in thoracoscopic radical lung cancer surgery by comparing the pain scores of ultrasound-guided transverse rib block and thoracic paravertebral block after thoracoscopic radical lung cancer surgery.Methods: A total of 60 patients,aged 20-65 years,ASA class I or II,BMI 18-28 kg/m2,undergoing thoracoscopic radical lung cancer surgery at the Second Affiliated Hospital of Nanchang University from June 2021 to December 2021 were selected.randomly divided into ultrasound-guided transverse rib block group(CTB group)or thoracic paravertebral block group(TPVB group).The patients were given an ultrasound-guided nerve block half an hour before the anesthesia in the preparation room,and 20 ml of 0.5% ropivacaine was injected at the level of the fourth thoracic vertebra.the main observation indexes were VAS at 1 hour after extubation,6 hours,24 hours,and 48 hours after surgery in the resting(resting)and active(coughing)states.secondary indexes: age,sex,BMI,ASA classification,operative time,hospitalization cost,and hospital days.Number of days of hospitalization;perioperative opioid dosage,time of starting postoperative ballooning,time of first analgesic pump press,number of effective analgesic pump presses and number of additional analgesic cases within 48 hours postoperatively;complications of nerve block and occurrence of adverse events within 48 hours.Results: A total of 60 patients participated in this trial,1 patient was discontinued due to intermediate open chest and 2 patients were not included in the study due to refusal to perform nerve blocks.Finally,28 patients in TPVB group and 29 patients in CTB group participated in the trial.1.There was no significant difference between the two groups in terms of ASA classification,BMI,length of stay,hospitalization cost,and other underlying conditions(P > 0.05).2.There was no marked difference in VAS scores between the two groups at 1 hour after extubation,6 hours after surgery,24 hours after surgery,and 48 hours after surgery in the sedentary state(P > 0.05).3.1 hour after extubation and 6 hours postoperatively when coughing,VAS scores were lower in the CTB group compared with the TPVB group(P < 0.05).4.24 hours postoperatively and at 48 hours postoperatively when coughing,there was no significant difference in VAS scores between the two groups(P > 0.05).5.There was no significant difference in opioid dosage between the two groups(P > 0.05).6.Within 48 hours after surgery,the CTB group pressed the analgesic pump less frequently compared with the TPVB group(P < 0.05);the CTB group pressed the analgesic pump later(P < 0.05);and patients in the CTB group started ballooning earlier(P < 0.05).7.There was no significant difference in the occurrence of intraoperative hypotension and postoperative nausea and vomiting between the two groups(P > 0.05).Conclusion: Ultrasound-guided costotransverse block can be used for thoracoscopic radical lung cancer surgery.