The Effect Of Early Postoperative Recovery In Patients With Dexmedetomidine Combined With Ropivacaine Thoracic Paravertebral Block In Thoracic Laparoscopic Combined With Radical Resection Of Esophageal Carcinoma

Objective:To observe the early postoperative analgesia,the stress,and the affect the quality of life about the application of thoracic paravertebral block(TPVB)ultrasound guided with dexmedetomidine combined with ropivacaine in combined laparoscopic and thoracoscopic esophageal cancer resection patients.Methods:Ninety patients with combined laparoscopic and thoracoscopic esophageal cancer resection were selected,then they were randomly divided into three groups:ropivacaine used in thoracic paravertebral block combined with general anesthesia group(TS group),dexmedetomidine with ropivacaine by TPVB combined anesthesia group(TD group)and control group(C group).Each groups consists of thirty patients,during the test,three patients were excluded per group which lead to twenty-seven patients per group ultimately.The three groups were consistent with the same general anesthesia,and TS,TD group received general anesthesia injection after 15 minutes of the paravertebral block.They were respectively given 0.375%ropivacaine 20ml and 1ug/kg dexmedetomidine with 0.375%ropivacaine 20ml in the right lateral thoracic paravertebral nerve block under ultrasound guidance.Intravenous analgesia electronic pumps were used for three groups postoperative.Recorded the propofol and remifentanil dosage and VAS score of postoperative resting and moving(cough and deep abdominal pressure)actions 1h,2h,4h,8h,12h,24h after the operation respectively.Meanwhile,measured IL-6,IL-8 level through internal jugular vein blood 2ml during preoperative(T1),intraoperative pleural the mirror into the chest(T2)and postoperative 24h(T3),recorded postoperative complications which include:the rate of respiratory depression,pulmonary infection,atelectasis,respiratory failure,arrhythmia,with 40 recovery quality scale assessment to assessed patients' quality of life before the surgery and 3 days and 1 months after the surgery.Results:Compared with the C group,the VAS score of the T1-T6 TD and TS group were significantly lower than that of the control group(p<0.05).Compared with the TS group,the VAS score of the T1-T6 TD group was significantly lower than TS group(p<0.05).Compared with C group,IL-6 and IL-8 levels were significantly lower in the TD and TS group during and 24h after the operation of thoracoscopic surgery(p<0.01).Compared with TS group,IL-6 and IL-8 levels were significantly lower in the TD group during and 24h after the operation of thoracoscopic surgery(p<0.05).Compared with the TS group,the QoR-40 score in the TD group was significantly higher at the end of operation and 3 days after operation(p<0.05).Compared with the C group,the QoR-40 score in the TD and TS group were significantly higher at the end of operation and 3 days after operation(p<0.05).Three groups of patients vital signs were stable,during the observation period(1 months after operation)they had no pulmonary infection,atelectasis,respiratory failure,arrhythmia and other related complications.There is no significant difference with the Propofol dosage.Compared with C group,Remifentanil dosage in TS,TD group were significantly reduced(p<0.01).Conclusion:Compared with ropivacaine compound general anesthesia,the dexmedetomidine combined with ropivacaine thoracic paravertebral nerve block composite anesthesia had less general anesthesia analgesic dosage,postoperative felt less pain,with less surgical stress response,and they received higher quality of life early after operation.Compared with simple anesthesia,paravertebral block composite anesthesia in the above aspects is better.