Effects Of General Anesthesia Combined With Thoracic Paravertebral Block On Postoperative Pain Reliese & Inflammatory Reaction In Modified Radical Astectomy

Background:Perioperative a variety of stimuli, such as emotional stress, trauma, pain and changes in effective circulating blood could stimulate patients with systemic inflammatory response. Modified radical mastectomy of its large range of surgical procedures, and the need for axillary lymph node dissection and postoperative needs and bandaged the wound drainage, these stimuli can increase the perioperative inflammatory response. Postoperative pain is a common complication of surgery. Patients due to pain, unwilling to deep breathing exercise, the effective cough reduced, leading to residual lung secretions, atelectasis and pneumonia. Severe postoperative pain, impair exercise capacity of patients, leading to increased perioperative complications, thus affecting the prognosis of patients, and may cause chronic postoperative pain syndrome, increase the cost of treatment of patients, affecting the quality of life of patients.Objective: To evaluate the effect of thoracic paravertebral block combined with TIVA for modified radical mastectomy on postoperative pain.Methods: Forty-eight female patients(36-70 years old), undertaking modified radical mastectomy, were equally randomized into intravenous-inhalation general anesthesia group and thoracic paravertebral block group. Respectively before anesthesia(S0), the start of surgery 30min(S1), the end of surgery(S2) and after 8 h(T8) recorded heart rate(HR) and mean arterial pressure(MAP) changes, blood samples were collected at the same time,Serum tumor necrosis factor-alpha(TNF-?), interleukin-6(IL-6) and IL-10 were determined by ELISA. After 1h, the patient VAS scores. The observation point is defined as T1, sequentially recorded after 4 hours, 8 hours, 16 hours, 24 hours(labeled T4, T8, T16, T24) at rest and during exercise VAS pain scores. Two groups were recorded in each patient intraoperative sufentanil total amount, PACU stay, postoperative intravenous analgesia(PCIA) patient-controlled analgesia press times, analgesia sufentanil consumption related to anesthesia and postoperative complications. In T1, T4, T8, T16, T24 when using the patient sedation Ramsay score assessment. At time T4 blood test Arterial blood gas, using a portable spirometer for patients forced expiratory volume in one second(FEV1), forced vital capacity(FVC) determination.Results: Compared with the S0, two groups of patients in S2 and T8, TNF-?, IL-6 and IL-10 expression was significantly increased(P<0.05); compared with the TIVA group, TIVA+TPVB group expression of TNF-? and IL-6 levels were significantly lower(P <0.05), while IL-10 expression levels were higher(P<0.05);TIVA+TPVB group in S1 and S2 in time HR was significantly lower(P <0.05), while MAP remained stable, while the same time TIVA group MAP was significantly higher(P <0.05); compared with the TIVA group, in S1 and S2 moment TIVA+TPVB group HR and MAP were lower than the TIVA group(P <0.05). TIVA+TPVB group after surgery and postoperative 8h 2,4h and quiet motion VAS scores were lower than the TIVA group(P <0.05). TIVA+TPVB group intraoperative sufentanil dosage, PACU stay time, PCIA sufentanil dosage and pressing times were lower than TIVA group(P <0.05). In T1, T4 and T8 three time points after sedation(Ramsay score) was statistically between the two groups of patients, TIVA+TPVB group is less than the TIVA group(P <0.05). 4h after two groups of patients Pa O2 and Pa CO2, FVC and FEV1, the difference was statistically significant, TIVA+TPVB group was stronger than TIVA group(P <0.05). TIVA+TPVB group after the number of cases of anesthesia-related complications than TIVA group, but there was no significant difference in the incidence.Conclusion: TPVB can effectively inhibit paraopperative inflammatory reaction in patients undergoing breast cancer surgery.Thoracic paravertebral block combined with general anesthesia when applied to breast cancer modified radical mastectomy patients, not only to provide more effective relief of acute pain effect, and can effectively reduce the total amount of perioperative opioids, reducing PACU residence time, more conducive to the resumption of early postoperative cognitive function and early respiratory function, while its related complications did not increase.