Ultrasound-guided Paravertebral Block In Elderly Patients Undergoing Pancreaticoduodenectom

Objective:To investigate the analgesic efficacy and safety of ultrasound-guided thoracic paravertebral block in elderly patients during open pancreaticoduodenectomy(PD).Methods:Forty patients between the ages of 65-80 with American Society of Anesthesiologist(ASA)?-? were randomly designated to observation group(20 cases)and control group(20 cases),Before general anesthesia,the observation group received the right thoracic paravertebral block(TPVB)and was given sufentanil patient controlled intravenous analgesia(PCIA)after operation.The control group was given general anesthesia alone,and the same sufentanil PCIA was given at the end of the operation.The data that has been recorded were including two groups of patients age,weight,gender,ASA status,operation time,urine volume and blood loss;the MAP and HR when resting(TO),2 min before skin incision(T1),2 min after skin incision(T2)and shortly before the end of operation(T3);the mean arterial pressure(MAP),heart rate(HR),respiratory rate(RR)and pulse oxygen saturation(SpO2)of two groups at different time points of 3h(T4),16h(T5),24h(T6)and 48h(T7)after operation;the bloodgas analysis to determine blood glucose level and lactate level when 30 minutes before operation and 30 minutes after operation;the numeric rating scales(NRS)of two groups at different time points of T4,T5,T6 and T7 after operation;the amount of intraoperative sulfentanil consumption,postoperative PCIA conpress frequency and the occurrence of adverse reactions after operation;Results:(1)There were no significant differences in age,weight,gender,ASA status,operation time,urine volume and blood loss between the two groups of patients(all P>0.05).(2)There was no significant difference between the two groups at the two time points of TO and TI(P>0.05),the MAP and HR in the observation group of T2and T3 was significantly lower than control group(P<0.05).(3)The MAP,HR,RR,and SpO2 measured at different time points over at T4,T5,T6 and T7 showed no significant differences among two groups(all P>0.05).(4)The blood glucose level of the observation group was lower than control group at 30 minutes before and after skin incision,the difference was statistically significant(P<0.05),there was no significant difference in the lactate level between the two groups before and after 30 min skin incision(P>0.05),and the blood glucose level of the two groups after skin incision were all higher than those before skin incision(P<0.05).(5)The NRS score showed significant differences among two groups in T4,T5,T6 and T7 after operation(all P<0.05).(6)The amount of intraoperative sulfentanil consumption and postoperative PCIA compress frequency showed significant differences among two groups.Compared with the control group,the amount of intraoperative sulfentanil consumption(0.7?g/kg vs 1.2 ?g/kg)were significantly reduced,and postoperative PCIA compress frequency(2.2 times vs 5.4 times)were significantly decreased(all P<0.05).(7)There were no significant differences in postoperative nausea,vomiting,respiratory depression,itching,urinary retention and delirium between the two groups of patients(all P>0.05).Conclusion:Ultrasound-guided TPVB combined with general anesthesia for the elderly PD,can reduce the sulfentanil consumption effectively during operation,ease postoperative pain and make hemodynamics more stable.Therefore,ultrasound-guided TPVB can be used as a better analgesic method for the elderly patients with open pancreaticoduo-denectomy.