Study On The Effect Of Ultrasound-assisted Bilateral Thoracic Paravertebral Block In Radical Gastrectomy

ObjectiveIn China,gastric cancer is one of the most common tumors^[1].Radical gastrectomy is the most effective treatment for gastric cancer.However,open radical gastrectomy has severe postoperative pain,which often limits the early postoperative activities of patients,and even leads to chronic pain.Epidural anesthesia is the gold standard for postoperative analgesia in radical gastrectomy for gastric cancer.The analgesic effect is mainly by injecting local anesthetic into epidural cavity to block nerve root,and to some extent alleviate the risk of respiratory inhibition and lower limb thrombosis.However,because of its urinary retention,Hypotension^[2-3],and its limitation of contraindication,restrict its clinical application.Studies have shown that paravertebral nerve block can produce effective anesthetic effects of axonal block and interabdominal block,accompanied by sympathetic nerve block.The effect is equivalent to that of unilateral epidural anesthesia with fewer complications.In addition,paravertebral nerve block has been widely used in other diseases,and good postoperative analgesia has been obtained for patients,such as thoracotomy.In this study,we observed the effect of bilateral paraspinal nerve block on open radical resection of gastric cancer,and discussed the effect of paraspinal nerve block on gastric cancer.To provide a new clinical anaesthesia and choice of postoperative analgesia for patients with open gastric cancer radical operation.Methods1.Study objects and groups:50 patients with open gastric cancer undergoing open radical gastrectomy?-?)were randomly divided into two groups:general anesthesia group?G group?and general anesthesia combined paraspinal nerve block group?group G?.Group P,25 cases in each group.2.Anesthetic method:Fasting and drinking was given before operation.After entering the room,the patients were monitored with BIS.The BIS value of group G was between40 and 60.Group G was treated with ultrasound guided paravertebral nerve block before general anesthesia:the patients were in the position of right lateral position,and the patients were in the right side position before general anesthesia,and the BIS values of group G were between 40 and 60,while the patients in group G were treated with ultrasound guided paravertebral nerve block before general anesthesia.Using Wisonic Navis ultrasonic diagnostic instrument,the high frequency probe was parallel to the intercostal space,the paraspinal space image was obtained,and the puncture needle was inserted into the bilateral T₇,T₈ and T₉ segment,there were 6 paravertebral intervertebral spaces.0.5%ropivacaine?5 ml,30 ml?was injected separately.After the supine position was changed,the analgesia regression method of acupuncture was used to determine the effective level of block.Group G was induced by routine general anesthesia,maintained by intravenous anesthesia,and treated with intravenous analgesia pump after operation?dose:sufentanil 3 g·kg^-11 flurbiprofen ester 100mg saline 100 ml?.3.Outcome measures:to record the mean arterial pressure?mean arterial pressure,MAP?and heart rate heart rate?heart rate,HR?at different time points?T0,T1,T1,T1,T2,T2,T3,T5,T4,T5,T6?at each time point after operation,and to observe the visual model of the patient at 2 minutes,8,12,24,48 hours after operation.To score visual analogue pain scaleto VAS,the dosage of analgesic drugs during and after operation,Tracheal extubation time and PACU stay time were observed to observe the incidence of complications.Results1.Comparison of general conditions:there were no significant differences in sex,age,ASA grade,body mass index,operation time and operation style between the two groups.2.Comparison of analgesic dosage in perioperative period:compared with group G,sufentanil was less in group P,and the dosage of two kinds of anesthetic in group P was lower than that in group G?P<0.05?.3.Comparison of MAP and HR during perioperative period in patients in group P?5min after operation?and 5 min after operation?T 2?and 5 min after operation?P<0 05?.The HR of group G was significantly lower than that of group G?P<0 05?at the time point of 5 min after operation and 5 min after operation,and at 20 min after operation,20 min after operation and 1 h after operation,and the HR of group G was significantly lower than that of group G?P<0.05?.4.Postoperative VAS score:in resting state,the difference of VAS score between the two groups was statistically significant?P<0.05?,and the score of group P was lower than that of group G?P<0.05?,and the score of group P was lower than that of group G?P<0.05?.The VAS scores in group P were significantly lower than those in group G at2 and 12 hours after operation?P<0.05?,but there was no significant difference at 24and 48 hours after operation.5.The duration of extubation and the postoperative complications in the two groups were also lower than those in group G?P<0.05?.The main postoperative complications in the two groups were hypotension.Among these complications,there was only significant difference in restlessness between the two groups,and the number of restless patients in group P was less than that in group G.ConclusionBilateral paraspinal nerve block combined with general anesthesia can maintain a more stable circulation fluctuation,reduce the use of analgesic drugs,reduce the intraoperative stress response,and benefit the patients with early extubation after operation.To provide a more stable and comfortable anaesthesia program to avoid the adverse consequences of acute postoperative pain and reduce postoperative restlessness.