| Background Esophageal cancer is one of the most common malignant tumors and also the 4th-leading cause of death in China.Unfortunately,the morbidity and mortality of lung cancer have in recent years.Moderate to severe pain still often occurs after thoracic surgery although minimally invasive technology has been widely used.Ultrasound-guided peripheral nerve block has the advantages of accurate positioning,clear analgesic effect,high safety and less complication.Therefore,it has been recommended for analgesia in the perioperation of thoracic surgery.In these work,we focus on the effect of peripheral nerve block in the managemet of postoperative acute pain in thoracic patients,and in order to further improve comfort and satisfaction of patients and provide a useful reference for the clinical.Objective 1)To study the effect of ultrasound-guided erector spinae block in postoperative acute pain of patients undergoing video-assisted thoracoscopic lobectomy,and whether the erector spinae block can provide good postoperative analgesia,reduce the amount of opioid analgesic medication,reduce the incidence of postoperative nausea and vomiting,shorten the length of hospital stay,and promote rapid postoperative recovery.To compare the effect of dexmedetomidine and dexamethasone as an adjuvant for the erector spinae plane block(ESPB)to control postoperative pain after video-assisted thoracoscopic lobectomy surgery(VATLS),and whether using dexmedetomidine(1?g/kg)or dexamethasone(10 mg),as an adjuvant of erector spinae block with ropivacaine,can prolonged sensory block duration,provided effective acute pain control,and required lesser rescue analgesia and shorter hospital stays.2)To study the effect of ultrasound-guided thoracic paravertebral nerve block in postoperative acute pain of patients undergoing thoracoscopic laparoscopic combined with esophageal cancer radical surgery,and whether thoracic paravertebral nerve block can provide good analgesic effect,reduce opioid analgesic dose,improve early postoperative pain,agitation and postoperative cognitive function,shorten hospitalization and promote rapid recovery after surgery.Method 1)Ninety patients who were scheduled to undergo video-assisted thoracoscopic lobectomy(VATLS),aged 20-65 years,male or female,Body Mass Index(BMI)15.1?26.2 kg/m2,American Society of Anesthesiologists(American Society of Anesthesiologists,ASA)grade I?II,were recruited and randomly divided into three groups,according to the injection drug formula of erector spinae plane block,R group:0.5%ropivacaine 30 ml;RS group:0.5%ropivacaine+10 mg dexamethasone 30 ml;RM group:0.5%ropivacaine+1?g/kg dexmedetomidine 30 ml,30 cases in each group.General information including gender,age,height,weight,BMI,ASA classification,the duration of operation time were calculated.The primary end point was postoperative PCA use during the first 72 h.Secondary outcomes included:a)consumption of sufentanil,remifentanil,and propofol during anesthesia;b)a 10 cm VAS for pain(0–10;0,no pain;10,worst imaginable pain)and changes in the VAS score at various time points:wake up in PACU and 2,4,6,8,12,24,48,72 h after surgery;c)optimum duration of sensory block;4)initial request for using PCA;and d)incidence of postoperative nausea and vomiting(PONV)and rescue analgesia in the ward and the hospital stay after surgery.2)Forty-eight patients accepted thoracoscopic and laparoscopic esophagectomy,40males and 8 females,aged 52-72 years,BMI 15.1-26.2kg/m~2,ASA physical status???,were recruited and randomly divided into general anesthesia group(group G,n=24)and general anesthesia combined with ultrasound-guided paravertebral nerve block group(group P,n=24).Both group P and group G received the same general anesthesia.Patients in group P received paravertebral nerve block guided by ultrasound before anesthesia induction.Medication including anesthetics and vasoactive agents in operating room and in PACU were calculated.Extubation time,PACU residence time,restlessness in PACU and VAS(visual analogue scale)in quiet and coughing conditions in analepsia,lefting PACU and 1,2,3,5d after operation were recorded.The mini-mental state examination(MMSE)scores of patients 1d before surgery and 7d after surgery were measured.The length of postoperative hospitalization and the incidence of postoperative cognitive disfunction(POCD)were recorded.Results 1)There was no significant difference in intraoperative characteristics among groups,which includes duration of surgery and the consumption of sufentanil,remifentanil,and propofol.Postoperative VAS scores at time-points of waking up in the PACU and 2,4,12,24 h after surgery in group RM decreased significantly than that in group R.Group RM demonstrated longer durations of sensory block and delayed first time of using the PCA machine than that in group R and group RS.Group RM demonstrated reduced total PCA machine use,the requirement for rescue analgesia,and postoperative hospital stay than group R and RS.There was no significant difference in the PONV occurrence rate among the groups.2)There was no significant difference(P>0.05)between two groups on gender,age,BMI,ASA classification,education level,preoperative complications.Compared to group G,the intraoperative consumption of propofol,remifentanil and sulfentanyl were significantly decreased in group P,and the consumption of phenylephrine was remarkably higher in group P(P<0.05).Compared with group G,the extubation time,the incidence of PACU agitation,the dosage of sufentanil used in PACU,the PACU stay time and length of postoperative hospitalization were significantly reduced in group P(P<0.01 or P<0.05).Compared with group G,the VAS scores in quiet and coughing conditions in analepsia,lefting PACU and 1,2,5d after operation and the VAS scores in coughing conditions in 3d after operation were remarkably decreased in group P(P<0.01 or P<0.05).Compared with 1d before surgery,the MMSE score of group G was significantly decreased on 7d after surgery(P<0.05).There were 2 cases(8.3%)of POCD in the group P and 6 cases(25.0%)in the group G 7 d after surgery,with no statistically significant difference in the incidence of POCD between the two groups(P>0.05).Conclusions 1)Using dexmedetomidine(1?g/kg),instead of dexamethasone(10 mg),as an adjuvant of ESPB with ropivacaine,prolonged sensory block duration,provided effective acute pain control,and required lesser rescue analgesia and shorter hospital stays.2)The general anesthesia combined with ultrasound-guided paravertebral nerve block(USG-PVB)can effectively reduce the consumption of perioperative opioid analgesic drugs,relieve the early postoperative pain and agitation of the patients undergoing thoracoscopic and laparoscopic esophagectomy(TLE),and shorten the hospital stay,thus facilitating the postoperative recovery. |
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