To Analyze The Curative Effect Of The Different Nerve Block Patterns And PCIA On Postoperative Analgesiain Patients Undergoing Video-assistanted Thoracoscopic Surgery

Objective:To explore the curative effect of the different nerve block patterns and PCIA on postoperative analgesiain patients undergoing video-assistanted thoracoscopic surgery,up to finding better analgesiain.Methods:1.Gather casesA total of 90 patients with American society of anesthesiologists(ASA)physical status ?-? undergoing video-assistanted thoracoscopic lobectomy(all of them were NSCLS)who had received between July 2016 and July 2017 at the 1st Affiliated Hospital of KMU.2.Divide into groupsThese were randomly and double-blind study allocted into three groups(n=30 each):group GI used intercostol nerve block(INB)and general anesthesia,then the thoracic surgeon start INB in the operative incision ahead of closed the chest.Group GP adopted to thoracic paravertebral block(TPVB)and general anesthesia,after that we started TPVB in the thoracic cavity prior to finished the operative.And group GU employed ultrasound-guide thoracic paravertebral block(UGTPVB),afterwards the anesthetist used ulthasound to start TPVB behind narcoticed the patients and deep vein catheterization.All of them were received intravenous anesthesia induction,orotracheal intubation was performed,and intravenous inhalational anesthesia was holded.After the patients returned the ward,the PCIA pump started.3.Target parameter settingWe recored the VAS score behind the surgery in 1h(T1)?2h(T2)?3h(T3)?24h(T4)?48h(T5).And the times of PCIA pump controlled or total background input during 24?48h.4.other parametersObserved the untoward effects:chest distress??somnolence?nausea?emsis?skin itch and respiratory depression.5.Statistical methhodsThe measurement data were expressed by deviation(x + s).The comparison between the three groups was analyzed by single factor variance,and the comparison of different points was used to analyze the variance of repeated measurements.Chi square test was used to compare the count data,and bilateral test was used for all the hypothesis tests.We think that the difference between the tested P and less than 0.05 is pregnant.Results:The analgesic effect of the three groups was basically satisfactory.Compared with the intercostal nerve group,the VAS score of the paravertebral group and the B ultrasound guided group in 1-3 hours of resting and coughing decreased significantly(P<0.05),and the number of press times and the total infusion volume of the two group of PCIA pumps at twenty-fourth and 48h paravertebral block after operation were significantly lower than those in the intercostal nerve group(P<0.05).Compared with the direct visual paravertebral group,there was no significant difference in the VAS score between T1?T3 GP group and GU group(P>0.05)during the resting and coughing group(P>0.05),and there was no significant difference between the 24,48h GP group and the GU group after the operation(P>0.05).There was no chest tightness and lethargy in the three groups.There were 12 cases of nausea and vomiting in the intercostal nerve group,3 cases(40%),3 cases(10%),9 cases(30%),2 cases(6.6%)in the chest direct vision group,10(33.3%)and 1(3.3%)in the B-ultrasound guide group,and the difference was no pregnant.There were 1 cases(3.3%)of skin pruritus in intercostal nerve group,while no case occurred in two groups of paravertebral block.No one patient had respiratory depression in the three group.Conclusion:The comparison of intercostal nerve block with thoracoscopic resection of lung cancer is compared with intercostal nerve block.The postoperative analgesia effect of paravertebral block or B-ultrasound guided percutaneous paravertebral block is better.After thoracoscopic surgery,there was no significant difference in the analgesic effect between intrathoracic direct paravertebral block or percutaneous puncture under B-mode ultrasound.