Effect Of Erector Spinae Plane Combined With Thoracic Paravertebral Nerve Block On Postoperative Recovery Quality Of Patients Undergoing Thoracoscopic Surgery

Background Lung cancer ranks first among malignant tumors,and thoracoscopic surgery is the first treatment for lung cancer.Good postoperative analgesia is essential for undergoing thoracoscopic surgery.In recent years,paravertebral nerve block and erector spinae plane block has been widely used for postoperative analgesia in thoracic surgery.We have consulted a large number of literatures and used the method of vertical spinal muscle plane combined with paravertebral nerve block in clinical practice.The analgesic time is longer than that of simple paravertebral nerve block,and the adverse reactions are less,but there is a lack of relevant data support at home and abroad.Objectives This study aims to compare the application of erector spinae plane combined with thoracic paravertebral nerve block and thoracic paravertebral nerve block alone in video-assisted thoracoscopic lobectomy,and to evaluate the effects of the two methods on postoperative recovery quality.To provide relevant data references for clinical application.Methods 62 patients from May 2022 to September 2022,ASAⅠ～Ⅱ,aged 30-65 years old,with BMI≤30kg/m~2,who underwent thoracoscopic lobectomy in Zhengzhou Central Hospital were selected.Informed consent was signed voluntarily by patients and their relatives and approved by the ethics committee.They were randomly divided into two groups:ultrasound-guided erector spinae plane combined with thoracic paravertebral nerve block group(ET group)and ultrasound guided thoracic paravertebral nerve block group(T group),31 cases in each group.Before induction of general anesthesia,ET group received unilateral T4 and T6 paravertebral nerve block and unilateral T4 erector spinal plane block under ultrasound guidance,while T group received unilateral T4 and T6 paravertebral nerve block under ultrasound guidance.Patient controlled intravenous analgesia(PCIA)was administered intravenously at the end of the operation.The general data of the two groups were recorded respectively;The dosage of sufentanil,remifentanil,norepinephrine during operation were recorded;The first pressing time,effective pressing times and the number of postoperative analgesic relief cases were recorded;NRS scores were recorded at rest and cough at 0h(T0),2h(T1),6h(T2),12h(T3),24h(T4)after recovery;Qo R-15scores were recorded on the first and second day after the operation;The time of pulling out double-cavity endotracheal intubation,incidence of postoperative nausea and vomiting,postoperative pulmonary complications and discharge time were recorded;Local anesthetic poisoning,pneumothorax,nerve injury,allergic reaction,puncture site infection,hematoma and other adverse reactions related to nerve block were recorded.Results There were no significant differences in general information,intraoperative drug dosage,NRS score at T0,T1 and T2 rest and cough after operation,number of postoperative analgesic remedies,extubation time,incidence of postoperative nausea and vomiting,postoperative pulmonary complications and discharge time between 2 groups(P>0.05);Compared with T group,the Qo R-15 score of ET group on the first and second day after surgery was increased,the time of first pressure on the analgesic pump was prolonged,the number of effective pressure on the analgesic pump was reduced,and the NRS score of postoperative T3 and T4 resting and coughing was decreased,with statistical significance(P<0.05);There were no adverse reactions related to nerve block in both groups.Conclusion Compared with simple thoracic paravertebral nerve block,erector spinal plane combined with thoracic paravertebral nerve block can prolong analgesia time and improve postoperative recovery quality of patients,providing reference for clinical application.