Comparison Of Quadratus Lumborum Block Versus Thoracic Paravertebral Nerve Block On Postoperative Analgesia And Immune Function In Radical Nephrectomy For Renal Cancer

Objective:To compared the effect of ultrasound-guided quadratus lumborum block?QLB?versus thoracic paravertebral nerve block?TPVB?combined with patient controlled intravenous analgesia?PCIA?with dezocine on postoperative analgesia and immune function in radical nephrectomy for renal cancer.Methods:A total of 90 patients who received laparoscopic radical nephrectomy for renal cancer were randomly divided into two groups:QLB group and TPVB group?n=45?.Ultrasound-guided QLB and PVB were respectively used in QLB and TPVB groups before induction of anesthesia.The primary outcomes were?1?postoperative analgesia during cough by recording the visual analogy score?VAS?at 0?4h,4?12h,12?24h and 24?48h after surgery,the effective number of PCIA presses,consumption of fentanyl.?2?Cellular immunity and humoral immunity on the first and third day after operation.The secondary outcomes including following contents:?1?General condition of the patient?2?Hemodynamic parameters at preoperative?T1?,after blockade?T2?,beginning of the operation?T3?,after renal resection?T4?and immediate postoperative?T5?.?3?surgical time,anesthesia time,wake up time,dosage of intraoperative analgesics,etc.?4?Incidence of adverse reaction including falls,nausea,vomiting,etc.Results:?1?General variables comparison:The age,sex,BMI and other general variables etc between these two groups were similar?P>0.05?.?2?Comparison of hemodynamic parameters:MAP,HR and Sp O₂ between these two groups at each time points were similar?P>0.05?.?3?Perioperative variables comparison:surgical time,anesthesia time,introperative analgesic dosage and recovery time etc between these two groups were similar?P>0.05?.?4?Comparison of postoperative analgesia and analgesic dosage:VAS score,effective number of PCIA compressions 0-4h postoperative cough between the two groups were not statistically significant?P>0.05?.Compared with the patients in the QLB group,the VAS score and the effective number of PCIA compressions were significantly reduced in the TPVB group during the period of 4-12h,12-24h and 24-48h postoperatively?P<0.05?.There was no statistically significant difference in fentanyl recovery amount between 0-4h,4-12h after surgery between the two groups?P>0.05?,but patients in the TPVB group had 12-24h after surgery and 24-48h after surgery,document help the amount of fentanyl recovery in the period was lower than that in the QLB group?P<0.05?.?5?Postoperative cellular and humoral immune function:CD3+,CD3+CD4+,CD3+CD8+,CD3-CD16+CD56+and CD19+level at the postoperative 1^stt day between these two groups were both similar?P>0.05?,Compared with the QLB group,the levels of CD3+CD4+and CD3+CD8+in the TPVB group on the 3rd day after surgery significantly increased?P<0.05?,but there was no significant difference in the levels of CD3-CD16+CD56+and CD19+on the 3^rdd day after surgery?P>0.05?.In the meantime,IgG,IgA,IgM at the postoperative 1^stday and 3^rdday between these two groups were both similar?P>0.05?,but the level of CRP and hs-CRP at the postoperative 1^stt day and 3^rdd day after surgery in TPVB group were both reduced in comparison with QLB group?P<0.05?.?6?comparison of the incidence of adverse:compared with the QLB group,the incidence of postoperative drowsiness,nausea and vomiting in the TPVB group was significantly reduced?P<0.05?.Conclusion:Both QLB and TPVB combined with dizocine PCIA can provide effective postoperative analgesia for patients undergoing laparoscopic radical nephritis surgery,but TPVB combined with dizocine PCIA has a better and more lasting analgesic effect,and can reduce postoperative cellular immune suppression and inflammatory response.