Comparison Of Analgesic Effects Of Different Regional Nerve Block Methods In Patients With Thoracoscopic Lobectomy Under ERAS Mode

Objective: This study compared the analgesic effects of paravertebral nerve block,intercostal nerve block and serratus anterior plane block on patients undergoing thoracoscopic lobectomy under enhanced recovery after surgery modeMethods:Seventy-five patients undergoing thoracoscopic lobectomy at Hospital were selected and managed in ERAS mode throughout the perioperative period,and randomly divided into paravertebral nerve block(PVB)group,intercostal nerve block(ICNB)group and serratus anterior plane block(SAPB)group,with 25 cases in each group.After induction of anesthesia,ultrasound-guided PVB,SAPB and thoracoscopic direct view ICNB were performed respectively,and a total of 20 ml of 0.5% ropivacaine+5mg dexamethasone was administered.Patient controlled intravenous analgesia(PCIA)was turned on after the surgery is completed.Finally,observation and recording of the three groups of patients the visual analogue score(VAS)of the three groups of patients at 2h,12 h,24h,36 h and 48 h postoperatively,the number of effective compressions of PCIA at 48 hours postoperatively,the time of regional block operation,the complications of regional block operation,the dosage of anesthetic drugs propofol,remifentanil and dexmedetomidine hydrochloride used for intraoperative intravenous maintenance,the number of postoperative remedial analgesia,the postoperative the incidence of complications and adverse reactions,postoperative extubation time and hospital discharge time.Results: A total of 69 patients were finally counted and analyzed.The VAS at each postoperative time point was less than 4 in all three groups,and at 12 h postoperatively,VAS cough and VAS rest were significantly lower in the PVB group than in the ICNB and SAPB groups(P<0.05),with no significant differences at the remaining time points.The number of effective compressions during 0-12 h was lower in the PCIA in the PVB group(0.87±0.52)than in the ICNB group(1.52±0.89,P <0.05).Among the three groups,the operation time in the PVB group(7.96 ± 2.2 min)was significantly higher than that in the ICNB group(3.7 ± 0.82 min)and SAPB(2.87 ± 0.69 min),which was statistically significant(P < 0.05).Also the operating time in the ICNB group(3.7±0.82 min)was higher than that in the SAPB group(2.87±0.69 min,P<0.05).There was no significant difference in the amount of intraoperative anesthetic drugs used(P>0.05).3(13%)patients in the PVB group caused hematoma during the nerve block operation,which was statistically different compared to the ICNB and SAPB groups(P<0.05).There was no significant difference in the number of postoperative remedial analgesia,postoperative complications and adverse events among the three groups(P>0.05).There was no significant difference in postoperative extubation time and discharge time among the three groups(P>0.05)Conclusions:1.PVB,ICNB or SAPB combined with PCIA in ERAS mode is effective for postoperative analgesia in patients undergoing thoracoscopic lobectomy.2.Early postoperative analgesia was better with PVB than with ICNB and SAPB,and analgesia with ICNB and SAPB was similar.3.The operation of PVB is complicated,but ICNB and SAPB are simpler and safer than PVB,with fewer complications,and are effective alternatives.