Effects Of General Anesthesia With Nerve Block Guided By Nerve Stimulator Or Ultrasound On Thoracic Surgery

Objective: Thoracic paravertebral block(TPVB)in patients undergoing thoracic surgery,has a better analgesic effect.The aim of the study was to compared with simple general anesthesia,intends to evaluate the anesthetic effect of the nerve stimulator or ultrasound-guided paravertebral block for patients undergoing thoracic surgery,and to explore its feasibility,safety and efficacy,and to provide the base for clinical practice.Methods:1 Eighty ASA I or II patients,aged 20 to 70 years old,with elective general anesthesia,ECG was routinely performed before surgery,with normal renal and hepatic function,no chronic pain history,no severe hypertension,heart disease,diabetes and other complications,no alcohol,drugs,narcotic drugs,no blood system diseases,willing to accept PCIA and pain score.2 Groups: according to ways of surgery were divided into: unarmed TPVB combined with general anesthesia group(group A)and nerve stimulator guided TPVB combined with general anesthesia group(group B),ultrasound-guided TPVB combined with general anesthesia surgery(Group C)and pure general anesthesia group(Group D).3 Observatory parameters:(1)Record the block level,the full onset time of block,success rate of block,the incidence of complications,and the depth of puncture.Mean arterial pressure(MAP),heart rate(HR)change were observed and recorded at different point-times:Observe records after entering the operating room(T0),after the success of paravertebral block(T1),post-intubation for 5 min(T2),before the end of surgery(T3),2 h after surgery(T4),24 h after surgery(T5)and measure the blood glucose levels in the morning and adrenocorticotropic hormone(ACTH)levels on the operation day and the 2nd day after operation.(2)Postoperative special circumstances within 24h:observe postoperative nausea and vomiting(PONV),respiratory depression(respiratory rate <7 times/min,SpO2<90%),dizziness,abdominal distension,pruritus,abnormal Bleeding at postoperative 24 h,and record the necessity of rescue pethidine.(3)Postoperative analgesia effect within 24h: patients arrive the PACU to start time,to assess the resting and activities(cough,take a deep breath)VAS pain score at postoperative 1 h,4 h,8 h,16 h,24 h respectively,namely 0 is painless,10 is unbearable pain;In each period and record the sufentanil injection dosage,and the effective pressure accumulation of PCIA pump.(4)Analgesic effect evaluation at postoperative 24 h: NRS satisfaction score of patients overall analgesic effect at postoperative 24h(0 for completely dissatisfied,10 for very satisfied).4 Statistical analysis results: apply SPSS 19.0 statistical software,measurement data were expressed by mean±standard,the rate was compared by using Chi-square tests,and the theoretical frequency was less than 5,chi-square test in theory when the frequency is less than 5,chi-square test with continuity correction(for fourfold table)or predictive value chi-square test(for contingency table),data between two groups were compared by t test,Comparison of multi-group analysis between groups was conducted using one-way ANOVA,multiple comparison between group were analyzed using the LSD test(with homogeneous variances)and Dunnett's T3 test(with heterogeneous variances).P < 0.05 for the difference was statistically significant.Results:1 Comparison of hemodynamic indexes between the four groups: MAP and HR was higher at T2 than that at T0 at each different time point in the group D,and the difference was statistically significant(P < 0.05);MAP and HR was lower at T5 than that at T0 at each different time point in the group A,and the difference was statistically significant(P < 0.05).MAP,HR of group A,group B and group C was lower than that of group D at T2,and the difference was statistically significant(P < 0.05).2 Comparison of stress index of patients between the four groups:the changes of the blood glucose levels in the morning and the adrenocorticotropic hormone(ACTH)levels was higher on the operation day than that on the 2nd day after operation in the group D,and the difference was statistically significant(P < 0.05).3 Comparison of blood gas analysis of patients between the four groups: PaO2 at T4 was higher than that at T0 in each group,and the difference was statistically significant(P < 0.05).PaCO2 of group A,group B and group C was lower than that of group D at T4,and the difference was statistically significant(P < 0.05);PaCO2 was higher at T4 than that at T0 in the group D,and the difference was statistically significant(P < 0.05).4 Comparison of propofol and fentanyl consumption between the four groups: the consumption of propofol and fentanyl of group A,group B and group C was lower than that of group D,and the difference was statistically significant(P < 0.05).5 Effect analysis and complications of regional block and its complications: the maximum segment number of block?segment number of block upward and segment number of block downward of group B and group C was more than that of group A,and the difference was statistically significant(P < 0.05).The depth of puncture of group A and group B was shallower than that of group C,and the difference was statistically significant(P < 0.05).The adjustment times of puncture sites and the times of met bone of group A was increased than that of group C,and the difference was statistically significant(P < 0.05).6 Comparison of Postoperative pain score at each different time point: the pain score of group B and group C was lower than that of group D during the resting state at postoperative 1 h,and the difference was statistically significant(P < 0.05);the pain score of group A and group B was lower than that of group C and group D during the resting state at postoperative 4 h,8 h,and the difference was statistically significant(P < 0.05);the pain score of group C was lower than that of group D during the resting state at postoperative 16 h,and the difference was statistically significant(P < 0.05).The pain score of group A and group B was lower than that of group C and group D during active state at postoperative 1 h,4 h,and the difference was statistically significant(P < 0.05);the pain score of group B and group C was lower than that of group D during active state at rescue pethidine 8 h,and the difference was statistically significant(P < 0.05);the pain score of group C was lower than that of group D during active state at postoperative 16 h,and the difference was statistically significant(P < 0.05).7 Comparison of the sufentanil injection dosage,and the effective pressure accumulation of PCIA pump,postoperative rescue pethidine,postoperative complications and analgesic satisfaction at postoperative 24 h: the sufentanil injection dosage,and the effective pressure accumulation of PCIA pump of group A and group B was less than that of group C and group D at postoperative 24 h,and the difference was statistically significant(P < 0.05);postoperative rescue pethidine of group D was more than that of group A,group B and group C at postoperative 24 h,and the difference was statistically significant(P < 0.05);analgesic satisfaction of group B and group C was higher than that of group D at postoperative 24 h,and the difference was statistically significant(P < 0.05);postoperative complications of group D was more than that of group A,group B and group C at postoperative 24 h,postoperative nausea and vomiting of group D was higher than that of group C at postoperative 24 h and the difference was statistically significant(P < 0.05).Conclusions:1 Unarmed or nerve stimulator guided or ultrasound-guided TPVB combined with general anesthesia undergoing thoracic surgery,characterized as hemodynamic stability,low stress response,less consumption of general anesthetics,increase postoperative analgesic efficacy,improve lung ventilation.2 Nerve stimulator guided or ultrasound-guided TPVB have the obvious superiority to Unarmed.They increased the positioning accuracy,number of segmental block and fewer complications.