Clinical Evaluation Of Continual Thoracic Paravertebral Block Guided By Nerve Stimulator For Pulmonary Lobectomy With One-lung Ventilation

Objective:Discuss the value of clinical application of continual thoracic paravertebral block guided by nerve stimulator for pulmonary lobectomy with one-lung ventilation.Methods:40patients (ASA I-II) scheduled for pulmonary lobectomy with one-lung ventilation (OLV) were randomized into2groups:group PVB which combined thoracic paravertebral bolck with general anesthesia versus group CEA which combined thoracic epidural anesthesia with general anesthesia,both groups inserted catheter into the paravertebral space and epidural space seperately for postoperative anagesia. Following indexes were recorded:MAP and HR at different times-points:before blockage (To)，15mins after blockage (T1),5mins after patients were placed in lateral decubitus position with double-lung ventilation (T2),15mins after one-lung ventilation (T3),30mins after one-lung ventilation (T4),45mins after one-lung ventilation (T5);Arterial blood gas and mixed venous blood gas; Pulmonary shunt fractions (Qs/Qt); Onset time of anesthesia; Levels of sensory blocked in both groups;Total consumptions of Propofol and remifentayl; PaO2and PaCO2at postoperative2h and24h; Postoperative pain scores(VAS) both when patients were in quiescent condition (Resting VAS) and had a cough(Cough VAS) at postoperative2h,24h,48h.Results:MAP descended significantly at T1than PVB at To in group CEA,which had statistical differences between the groups (P<0.05);pulmonary shunt fractions in both groups begun to advance at T2, and no significant statistical differences were noted between the groups (P>0.05);no significant statistical differences in total consumptions of propofol and remifentayl were noted between the groups(P>0.05), which means anaesthetic efficacies of both groups were comparative. Postoperative Cough VAS in the PVB group was lower than it in the EA group (P<0.05); Patients had a higher PaO2at postoperative2h and24h in the PVB group than it in the CEA group (P<0.05).Conclusion:Thoracic Paravertebral block for surgery with one-lung ventilation which had less influences on hemodynamics, exact anaesthetic efficacies.comparative influences on pulmonary shunt fractions to epidural anesthesia,and resulted in better postoperative pain relief in motion and better oxygenation had clinical application value.