Clinical Application Of Ultrasound-guided Thoracic Paravertebral Block In Thoracotomy

Objective:To evaluate the application of ultrasound-guided thoracic paravertebral block compared with epidural in thoracotomy.Methods:80 lung cancer patients (ASA Ⅰ～Ⅱ), scheduled for elective thoracic surgery, were randomly divided into two groups (n=40 each):ultrasound-guided group (group PVB) which combined thoracic paravertebral block with general anesthesia and thoracic epidural group (group CEA) which combined thoracic epidural anesthesia with general anesthesia, both groups inserted catheter into the paravertebral space and epidural space seperately for postoperative analgesia. After TPVB block and CEA block, the onset time of anesthesia, the blocked dermatomes, and complications were recorded, HR and MAP were also recorded at before blockage (T0),15mins after blockage (T1), before induction (T2),5mins after patients were placed in lateral decubitus position with double-lung ventilation (T3),15mins after one-lung ventilation (T4),30mins after one-lung ventilation (T5),45mins after ong-lung ventilation (T6), and recorded arterial blood gas and mixed venous blood gas and pulmonary shunt fractions (Qs/Qt) at these times-points as well. The total consumptions of Propofol and fentanyl, the consumptions of vasoactive drugs were recorded. The awakening time and extubation time were also recorded. PaO2 and PaCO2 at postoperative 2h and 24h; Postoperative pain scores (VAS) both when patients were in quiescent condition (Resting VAS) and had a cough (Cough VAS) at postoperative 6h,12h,24h,48h were recorded. Recorded the postoperative pulmonary complications in a week.Results:The onset time of the sensory block in group PVB is shorter than group CEA, and the level of sensory block in group CEA is wider than group PVB;MAP descended sgnificantly at T1 and T2 than 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 T3, and no significant differences were noted between the groups (P>0.05); no significant statistical differences in total consumptions of propofal and fentanyl were noted between the groups (P>0.05), which means anaesthetic efficacies of both groups were comparative. The awakening time and extubation time of PVB group were shorter than CEA group (P<0.05). Postoperative cough VAS in the PVB group was lower than it is in the CEA group (P<0.05); Patients had a higher PaO2 at postoperative 2h and 24h in the PVBgroup than in the CEAgroup (P<0.05). The postoperative pulmonary complications of PVB group were lower than CEA group (P<0.05)Conclusions:Compared with thoracic epidural thoracic paravertebral block by ultrasound guided provide less influences on hemodynamics, exact aneasthetic efficacies comparative influences on pulmonary shunt fractions, and better oxygenation had clinical application value.