The Application Of Ultrasound-guided Bilateral Paravertebral Nerve Block Combined General Anesthesia In Laparoscopic Cholecystectomy

Objective:To analyze the effects of general anesthesia and ultrasound-guided bilateral paravertebral nerve block combined with general anesthesia about hemodynamics and postoperative analgesia in laparoscopic cholecystectomy.Methods:82 cases of patients,whose ASA ?-? grade,age between 18-60 years old,height 155cm-175cm,weight between 45-65Kg,undergoing laparoscopic cholecystectomy at our hospital from June 2017 to January 2018 were randomly divided into A group and B group,41 patients in each group,routinely monitored 5-lead electrocardiogram(ECG),oxygen saturation(SpO2)and non-invasive blood pressure(NIBP).Both groups were performed conventional general anesthesia induction and intubation before surgery.In group A,10 ml of 0.5%ropivacaine was injected into the bilateral T5 and T6 gaps before induction by ultrasound.In group B,10 ml equivalent of physiology was injected at the same location using the same method.In saline,postoperative intravenous self-controlled analgesia pump(PCIA)was performed in both groups.The hemodynamic changes at different time points in the two groups(t1 in the ventricular access,t2 in the nerve block,t3 in the intubation,t4 in the incision,and t5 in the extubation),VAS scores and Ramsay scores at 0,3,6,12 and 24 hours after operation,the first PCIA.pressing time and 24-hour postoperative analgesia pump fluid consumption and adverse reactions Incidence were analyzed.Results:1.Compared with group B,SBP,DBP,MAP and HR were lower in group A at t3,t4,and t5(P<0.05),whereas no statistical changes in hemodynamics were observed in t1 and t2.2.The VAS scores at each time point in groups A and B were Oh(3.51 ±1.57 vs 5.41±1.28),3h(4.66±0.66 vs 5.98±0.27),6h(5.02±0,16 vs 6.10±1.09),12h(4.00± 0.00 vs 4.90 ± 0.30)and 24 h(2.00±0.00 vs 2.73±0.45),all statistically significant(P<0.05).3.The Ramsay score in group A was lower than that in group B(3.41 ±0.50 vs 4.61±0.70;P<0.05),but there was no difference at other time points(P>0.05).4.The first PCIA time in group A and group B was(422.63±45.92 vs 260.95±3 6.31 mins),which was statistically significant(P<0.05),but the total consumption of analgesic pump fluid was of no difference(62.00±3.67 vs 59.88±5.85;P>0.05)at 24 hours after operation in both groups.5.The incidence of adverse reactions in group A and group B was 9.8%and 26.8%,respectively,with statistical significance(P<0.05).Conclusion:Ultrasound-guided bilateral paravertebral nerve block combined with general anesthesia can reduce the intraoperative stress response,maintain hemodynamic stability,reduce postoperative acute pain and complications,and is suitable for clinical application.