Effect Of Thoracic Paravertebral Block On Intraoperative Hemodynamics And Postoperative Recovery In Patients Undergoing Lobectomy

Objective:By observing the changes of intraoperative hemodynamics and postoperative recovery of patients underwent video assisted thoracic lobectomy with general anesthesia compound ultrasound guidance thoracic paravertebral block,we discussed the clinical value of thoracic paravertebral under the concept of enhanced recovery after thoracoscopic surgery.Methods:60 patients underwent thoracic lobectomy were randomly divided into two groups: totol intravenous anesthesia group(group GA)and thoracic paravertebral nerve block combined general anesthesia group(group TA).Preoperatively 0.5% ropivacaine 15 ml was used to TA patients for thoracic paravertebral block and the two groups of patients were treated with totol intravenous anesthesia.Records:(1)Gender,Age,ASA,BMI,EF.(2)The operation time,the extubation time,the postanesthesia care unit residence time,the usage of the propofol,the usage of opioid and the vasoactive drugs.(3)Heart rate(HR),mean arterial pressure(MAP),cardiac output(CO),cardiac output index(CI),stroke volume(SV)at the time of operation room admission(T0),after induction(T1),lateral position(T2),single lung ventilation(T3),after skin incision(T4),tracheal clip(T5),the end of surgery(T6).(4)Arterial blood gas analysis after operation room admission and after extubation.(5)The VAS and Ramsay score of the patient after extubation and the incidence of complications of the patient.Results:(1)There was no difference between the group in gender,age,ASA,BMI,EF(P> 0.05).(2)There was no difference between the group in operation time,extubation time,postanesthesia care unit residence time,the usage of propofol,the usage of remifentanil and vasoactive drugs between the two groups(P> 0.05).The amount of sufentanil used in the two groups was statistically different(P <0.05).(3)The HR in group TA at T1 and T6 was statistically lower compared with group GA(P<0.05).The CO in group TA at T6 was statistically lower compared with group GA(P<0.05).The CI and SV in group TA at T5 and T6 was statistically lower compared with group GA(P<0.05).There was no difference between the group in MAP(P> 0.05).(4)Preoperative blood glucose was not statistically different(P>0.05).The postoperative blood glucose in group TA was statistically lower than in group GA(P<0.05).(5)The VAS score in group TA after extubation was significantly lower than in group GA(P<0.05).There was no difference between the two groups in Ramsay score and the incidence of complications(P>0.05).Conclusions:1.Thoracic paravertebral block can cause short-time decrease in the heart rate cardiac output,cardiac output index and stroke volume but the trend of intraoperative hemodynamic is stable during thoracoscopic lobectomy.2.Thoracic paravertebral block can perfect postoperative analgesia,reduce the usage of opioids and does not increase the risk of anesthesia complications.