Ultrasound-guided Bilateral Thoracic Paravertebral Block For Radical Gastrectomy

Objective:Gastric cancer is a common malignant in the world.Its treatment is commonly based on surgical operation known as radical gastrectomy.The analgesic effect of TPVB in thoracotomy is good,but however,the use of TPVB in gastric surgery has not been previously studied.Thus,this study intends to investigate the perioperative analgesic effect of TPVB in patients with radical gastrectomy.Method:Randomly selected 60 patients scheduled for radical gastrectomy were divided into two groups according to the random number table:30 cases in the test group?Gp group?and 30 cases in the control group?Gc group?.They were without limitation of age and gender,body mass index?BMI?of 18²7 kg/m² and ASA physical status was?^?.There was no significant abnormalities in cardiopulmonary function.After entering the operation room,the electrocardiogram?ECG?,heart rate?HR?and saturation of pulse oximetry?SpO₂?were monitored with a multifunctional monitor.The radial artery and right internal jugular central venous catheters were placed to monitor the continuous ABP and CVP.Gp group:Ultrasound-guided bilateral TPVB in T8^T9 was performed before anaesthesia induction,and 15ml of 0.5%ropivacaine hydrochloride was given to each side ultrasound images showed dilated paraspinal space and subpleural pressure indicated the success of TPVB.The block plane was measured 20 minutes after,and the range of the plane was recorded.The control group?Gc?is patient with no special treatment.Routine anaesthesia induction and maintenance were performed 15-20 minutes later.If the blood pressure was lower than 20%of the baseline during the operation,ephedrine of 6 mg would be given,and If the heart rate was lower than 50 bpm,atropine of 0.3 mg would be given.Patient-controlled intravenous analgesia pump?PCIA?was used in both patients groups after surgery.Observation indicators:1 Intraoperative hemodynamic monitoring.2 VAS scores of 1h,6h,12h,24h,48h after the operation;The number of pressing the PCIA.3 Intraoperative remifentanil dosage.4 Intraoperative use of ephedrine and atropine.5 Adverse events.Results:1.In this study,30 patients in the experimental group had a block plane and all of them were in the range of thoracic 6¹2.2.Comparison of patients general data,there were no significant differences between the two groups?P>0.05?.?Table1?3.Comparison of patients'intraoperative hemodynamics:There were no significant differences in MAP and HR at T0,T1 and T5between the two groups?P>0.05?.There were significant differences between the two groups in mean arterial pressure?MAP?and heart rate?HR?at T2,T3 and T4?P<0.05?.?Fig.3??Fig.4??Table2?There was no statistical difference in Sp O₂ between the two groups at each time point?P>0.05?.4.Comparison of the VAS scores after operation:There were significant differences in the VAS scores at the rest and cough at 1h,6h and 12h after surgery between the two groups?P<0.05?and the VAS scores of the Gp group was significantly lower than that of the Gc group,while the difference was not significant between the two groups at 24h and 48h after surgery?P>0.05?.Within 48 hours after the operation,the frequency of pressing the PCIA in Gp group was significantly lower than that in Gc group?P>0.05?.5.There were significant differences between the two groups in the consumption of remifentanil?P<0.05?.6.The use of ephedrine and atropine in the operation,and the incidence of adverse events showed no statistical difference between the two groups?P>0.05?.Conclusion:Ultrasound-guided thoracic paravertebral nerve block?TPVB?in the 8th to the 9th segment of the chest can help to maintain hemodynamic stability during radical gastrectomy,and relieve perioperative pain significantly,without adverse events.