| Expriment 1Objective: To observe the analgesia effect of ultrasound-guided thoracic paravertebral nerve block(TPVB)and erector spinae plane block(ESP)in patients undergoing thoracoscopic lobectomy.Method:Ninety patients who were scheduled to undergo thoracoscopic lobectomy were randomly allocated in three groups(n=30 in each group),TPVB group(group P),ESP group(group E)and control group(group C).Inclusion criteria: Patients with unilateral lobectomy underwent thoracoscopic surgery in the same group were classified as Grade I-III according to the American Society of Anesthesiologists(ASA),aged 50-65 years,with body mass index(BMI): 18.5~24kg/m2.TPVB was given to patients in group P before anesthesia induction,ESP was given to patients in group E before anesthesia induction.All three goups received intravenous controlled analgesia after surgery.Pain scores at rest and during coughing and Ramsay scores were measured to the extubation(T1),12h(T2),24h(T3),48h(T4)after surgery.Compression numbers were recorded.The rate of bed removal within 24 hours after operation,sleep satisfaction scores,analgesia satisfaction scores,incidence of postoperative nausea and vomiting,as well as the other adverse reactions or complications were analysed.Result:1.The pain scores at rest and coughing of group P and group E on T1 did not differ significantly while they both lower than group C(P<0.05);On T2,the pain scores at rest and coughing are less than that in group C,and the coughing pain scores of group P are less than group E,there were statistically significant on all above(P<0.05).The pain scores at coughing of group P and group E were lower than that of group C(P<0.05),and the group P was lower than that of group E(P<0.05).There were no statistically significant difference between the three groups on T4.Compression numbers in group P and group E were significantly less than those in group C.And the compression numbers of group P are less than group E,but there were no statistically significant difference between them(P>0.05).2.The Ramsay scores were higher in group P and group E than the group C on T1,and there were no statistically significant difference between the group P and group E.3.The sleep satisfaction scores and analgesia satisfaction scores was greater in the group P and group E obviously after operation(P<0.05);4.Nausea and vomiting occurred less frequently in the group P and group E(P<0.05);The bed removal rate of the group P and group E was significantly higher at 24 h than that of the group C,and the difference was statistically significant(P<0.05).Conclusions: The analgesia effect of untrasound-guided TPVB and ESP were superior to PCIA for the perioperation of patients with thoracoscopic lobectomy.TPVB is a more efficient method which was beneficial to the early recovery of patients.Experiment 2Objective:To observe the effect of continuous thoracic paravertebral nerve block(CTPVB)under ultrasound guidance combined with oral celecoxib on the quality of early recovery in patients undergoing thoracoscopic lobectomy,so as to explore a reasonable multimodal analgesia scheme that is conducive to accelerating the rehabilitation of patients undergoing thoracic surgery.Method:This study selected 60 lung cancer patients who underwent selective thoracoscopic lobectomy from July 2017 to July 2018 in Linyi People's Hospital.Inclusion criteria: Patients with unilateral lobectomy underwent thoracoscopic surgery in the same group were classified as Grade I-III according to the American Society of Anesthesiologists(ASA),aged 50-65 years,with body mass index(BMI): 18.5~24kg/m2.The subjects in the experimental group used CTPVB combined with oral celecoxib,while the subjects in the control group used the traditional patient-controlled intravenous analgesia.Pain scores at rest and during coughing and Ramsay score were measured to the extubation(T1),24h(T2)and 48h(T3)after surgery.Dosage of dolantin for 48 h after operation,the rate of bed removal within 24 hours after operation,sleep satisfaction scores,analgesia satisfaction scores,incidence of postoperative nausea and vomiting,as well as the other adverse reactions or complications were analysed.Result:1.The pain scores on T2 did not differ significantly between the experimental group and the control group;the pain scores were lower in the experimental group at rest and on coughing than the control group on the remaining time points(P<0.05)while the dosage of dolantin for 48 h were lower in the experimental group(P<0.05);2.The Ramsay score was higher in the experimental group than the control group on T1;3.The sleep satisfaction scores and analgesia satisfaction scores was greater in the experimental group obviously on the first day and second day after operation(P<0.05);4.Nausea and vomiting occurred less frequently in the experimental group(P<0.05);5.The bed removal rate of the experimental group was significantly higher at 24 h than that of the control group,and the difference was statistically significant(P<0.05).Conclusions:Continuous thoracic paravertebral nerve block under ultrasound guidance combined with oral celecoxib is applied for the whole perioperative analgesia could cause analgeisic effect obviously,and effectively reduce the use of opioids,reduce the related complications,which is beneficial to the early rehabilitation of patients with lung cancer surgery. |
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