Clinical Observation Of Ultrasound-guided Bilateral Thoracic Paravertebral Nerve Block For Anesthesia In Liver Surgery

ObjectiveUsing bilateral ultrasound-guided thoracic paravertebral block combined with general anesthesia in clinical anesthesia of liver surgery,explore its effectiveness and safety,and to provide evidence for the use of this anesthesia method in the operation of partial removal of the liver.MethodsA total of 130 patients undergoing elective the operation of partial liver resection in the department of Hepatobiliary Pancreatic and Splenic Surgery of our hospital were selected and divided into the C group（control group）（n=65）and the T group（observation group）（n=65）according to their informed consent of anesthesia.After entering the operating room,every enrolled patient was given dexmedetomidine with1μg/kg intravenously pumped in 10min before puncture（T group）or anesthesia induction（C group）.Patients in C group received simple general anesthesia,the T group received bilateral ultrasound-guided TPVB on the basis of C group,and 20ml of ropivacaine（0.25%）was administrated to the both left and right sides respectively.Subsequently,all patients received equal amounts of PCIA for analgesia after surgery.Hemodynamic indexes（MAP and HR）of patients in C group and T group were observed and taked detail record at the time-point before puncture or anesthesia（T₀ for short）,the 3min before skin resection（T₁for short）,the 3min after skin resection（T₂for short）,the 15min after skin resection（T₃for short）,the immediately after the surgery（T₄for short）and the 30min after the surgery（T₅ for short）,and dosage of medium-and long-acting opioids（sufentanil）consumpted during operation were recorded,meanwhile,every patient was followed up at 2h,4h,8h,24h and 48h after surgery,and the VAS score at rest,the RAMSAY score at sedation,and whether the PONV was occurred within 48 hours after surgery were observed and recorded respectively.ResultsThere were no statistical significance differences in age,gender,height,weight,BMI and the general information between two groups（p>0.05）,also there were no statistical significance differences in surgical method and the hemodynamics before the anesthesia puncture（T₀）between two groups（p>0.05）.Intraoperative conditions:Compared with C group,the fluctuation effect of the hemodynamics in T group at T₁,T₂,T₃,T₄ was much smaller than that in C group,that is,the hemodynamics was more stable.The consumption of medium-and long-acting opioids during surgery:The T group（（?）=27.02,s=6.66）μg was significantly lower than the C group（（?）=38.91,s=7.14）μg.F（1,109）=82.17,p<0.001,η_p²=0.430;Postoperative situation:The resting VAS score were recorded at each observation point,the T group was lower than the C group at all observation point,F（4,436）=20.57,p<0.001,η²=0.425;However,the difference of the two groups’resting VAS score at 2h,4h and 8h after surgery was more significant,while the difference was smaller between the two groups at 24h and 48h after the surgery.The incidence of PONV was 20.4%in T group and 36.8%in C group;There was no significant difference in postoperative RAMSAY sedation score between the two groups,F（1,109）=0.005,p=0.943.None of the 54 patients in T group had pneumothorax,bleeding,nerve injury and other complications of thoracic paravertebral block during perioperative period.ConclusionsThe ultrasound-guided bilateral TPVB combined with general anesthesia for clinical anesthesia of partial removal of the liver,can make the hemodynamic of patients more stablely during intraoperative and reduce the consumption of medium-and long-acting opioids in the operation,In addition,the incidence of PONV was reduced,and the postoperative resting VAS score was decrease,so with high safety,Itcan be used as a safe and effective anesthesia for partial hepatectomy.