| Objective Anesthesia techniques and drug selection can interact with the cellular immune system and affect long-term outcomes.Paravertebral nerve block attenuates surgical stress responses by blocking afferent nerve conduction.At present,there is no research in domestic on the effect of paravertebral nerve block on cellular immune function undergoing modified radical mastectomy,and less in global.This study was to evaluate the effect of ultrasound-guided thoracic paravertebral nerve block cooperate with total venous anesthesia on perioperative cellular immune function in patients undergoing modified radical mastectomy,so as to provide reference for clinical anaesthesia.Methods Eighty patients who underwent modified radical mastectomy at Zhongshan Hospital Affiliated to Dalian University from July 2017 to December 2017 were randomly divided into experimental group(GA-c PVB)and control group(GA).GA-c PVB group underwent ultrasound-guided thoracic paravertebral block and propofol intravenous anesthesia,and insert a catheter to allow postoperative regional analgesia.GA group underwent intravenous anesthesia with a insertion of a laryngeal mask,and postoperative intravenous analgesia was allowed.(1)Collect peripheral venous blood at preoperative situation,0.5h(T0)before surgery,intraoperative situation,1h after incision(T1),postoperative situation,2h(T2),24 h(T3),48 h(T4),72 h(T5)after the surgery to measure NK cell and numbers and the proportion of CD3+ CD4+ CD8+ in total T lymphocytes by flow-cytometry,and calculate the ratio of CD4+/CD8+.(2)Evaluate the score of hospital anxiety and depression scale(HADS)include the anxiety and depression respectively;(3)Collect the VAS scores at 5h,2h,8h,24 h,48h and 72 h after operation.(4)Record sufentanil and propofol consumption,total infusion volume as weal as Mean arterial pressure and Heart rate.Results(1)T cell subsets: the proportion of CD3+ CD4+ in total T lymphocytes : In the time of 1 h after incision(T1),both group's value are all descend and there was a significant difference in comparison with baseline(T0)(P<0.05),especially in 2h after surgery(T2).And then,there was a steadily recovery in two groups,that 48 h After surgery(T4),the GA-c PVB group recovered to baseline(P>0.05),however,The GA group was still lower than the baseline 72 hours after surgery(P <0.05).In comparison with GA group,the value was higher in GA-c PVB group excluded(T0).There was no significant difference between the two groups in the percentage of CD8 + T lymphocytes(P>0.05).The levels of CD4 + / CD8 + in both groups decreased gradually from 1 h after incision,which were lower than the baseline(P<0.05),24 h After surgery(T3),the GA-c PVB group had been recovered to baseline(P>0.05),and GA group were not.(2)NK cells: GA group was lower than GA-c PVB group(P<0.05)excluded T0.The number of NK cell was the lowest at 2h after operation(T3)in GA-c PVB group,and there was a significant difference in comparison with T0(P> 0.05).After that,there was a rise in GA-c PVB group,and 72 h after operation,there was no difference with T0(P>0.05).In the group of GA,the lowest was found at 1h after skin incision(T2),but gradually recovered after that,but still lower than the baseline(P <0.05).(3)VAS score in rest was lower than 40 mm in both groups,there was a clinical satisfaction on analgesia.Compared with GA group,there was no significant differences in VAS scores between GA groups.(P>0.05).(4)There was no significant difference in HADS scores between the two groups before surgery(P> 0.05).(5)Sufentanil consumption: sufentanil had been added before incision and axillary lymph node dissection in GA-c PVB group.The consumption of sufentanil in GA-c PVB group and GA group were 15.2 ± 5.9?g and 38.1 ± 6.4?g respectively(P <0.05),propofol consumption and total infusion as weal as Mean arterial pressure and Heart rate had no difference between groups.(P>0.05).Conclusions Ultrasound guided thoracic paravertebral nerve block combined with propofol intravenous anesthesia in the modified radical mastectomy for breast cancer has less immunosuppression and less opioids consumption than intravenous anesthesia,and effectively relieve postoperative pain.More over,the immune function recover faster than that of total intravenous anesthesia after surgery.However,the effect of paravertebral block on immune cells is attributed to the use of paravertrapies or the reduction in the use of opioids remains unknow.However,patients with breast cancer who underwent general anesthesia had severe immunosuppression compared with those who underwent paraspinal block have been proved.We hypothesize that Thoracic paravertebral nerve block may improve the suppression of surgery and opioids on immune function. |
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