Effect Of Laryngeal Mask Combined With Nerve Block General Anesthesia With Spontaneous Breath On Enhanced Recovery After Video-assisted Thoracic Surgery

Research backgroundEnhanced recovery after surgery(ERAS)refers to the use of some improved clinical approaches during the perioperative period to limit the response to surgery and anesthesia stress and reduce the incidence of postoperative complications in order to achieve the goal of rapid recovery for patients.The concept of rapid rehabilitation surgery is applied in multiple disciplines,and the accelerated rehabilitation of thoracic surgery focuses on preoperative optimization,early postoperative activities,minimally invasive surgical approach,fluid management and pain control.With the development of medical imaging technology,many thoracic diseases are detected,and most diseases can be treated with thoracoscopy.The traditional anesthesia method of thoracoscopy is general anesthesia with double-lumen bronchial intubation.There are many pulmonary complications such as airway injury,acute lung injury,lung infection,and atelectasis.And have severely affected patients'rapid recovery,prolonged hospital stays,increased medical costs,and increased patient burdens.The incidence of complications after thoracic surgery is as high as 12%to 40%,while pulmonary complications are prolonged hospital stays and the main reason for living in the intensive care unit(ICU).Postoperative immune function is related to surgical trauma,anesthesia,stress,intraoperative bleeding,hypotension and hypothermia etc.It is an important influencing factor for infection,sepsis,tumorigenesis,protecting patients'immune function,preventing postoperative pulmonary complications,can be directly affecting surgical results and rapid recovery after surgery.Nerve block is beneficial to the recovery of postoperative immune function and nerve block can reduce the postoperative pulmonary complications,accelerate the recovery of gastrointestinal function in patients,prevent deep vein thrombosis,reduce the use of opioids during and after surgery,etc.Significantly promote postoperative rehabilitation of patients.ObjectiveThe objective of this study was to investigate the effects of laryngeal mask combined with nerve block retention spontaneous breathing anesthesia on rapid recovery and compare the effects of ultrasound-guided thoracic paravertebral nerve block and serratus plane block after thoracoscopic surgery in patients.MethodNinety patients aged 18~65 years,BMI 18~24 kg/m~2,ASA physical status I or II,undergoing thoracoscopic surgery were selected and the surgical methods included:thoracoscopy lung wedge resection,thoracoscopy bullae resection,and thoracoscopy lobectomy.They were divided randomly into three groups:the spontaneous breathing TPVB and SPB experimental group and the tracheal intubation mechanical ventilation control group.Collect intraoperative and postoperative clinical data of the three groups of patients,such as intraoperative blood pressure,heart rate,arterial oxygen saturation and intraoperative blood loss;record Ramsay scores and rest/Cough visual analog score(VAS)at 2,4,6,12,24and 48 hours after surgery,cumulative use of sufentanil,effective number of Patient-controlled analgesia compressions,postoperative first time farting,postoperative first meal time,and postoperative first time to get out of bed,etc.Rehabilitation-related indicators.The plasma cortisol and CRP levels were measured and the differences between the there groups were compared before and after anesthesia.Result1.From March 2019 to September 2019,a total of 90 patients were included in the study,of which 1 in the TPVB group and 3 in the SPB group withdrew from the study due to changes in the method of anesthesia.There were 56 patients,including29 patients in the TPVB group and 27 patients in the SPB group;30 patients were included in the endotracheal mechanical ventilation control group.2.Among the three surgical approaches the general situation of the anesthesia in the experimental group and the control group:blood pressure,heart rate,arterial oxygen saturation,and operation time were not significantly different(P>0.05);Ramsay score,visual analog score(VAS)at rest/cough at 6,12,12,24,and 48 hours,cumulative use of sufentanil,effective number of Patient-controlled analgesia compressions,postoperative first time farting,postoperative first meal time,postoperative first time to get out of bed and postoperative complications were statistically significant(P<0.05).The TPVB group and the SPB group in the experimental group were VAS at rest at each time point there was no significant difference in the scores(P>0.05),compared with the TPVB group,the VAS at cough score was lower in the SPB group at 6 h and 12 h,the nerve block time was longer in the SPB group,and the effective number of Patient-controlled analgesia compressions.there were fewer compressions and less cumulative opioid use(P<0.05).3.The levels of plasma CRP and cortisol were significantly lower in the experimental group than in the control group(P<0.05);there was no significant difference between the TPVB group and the SPB group in the experimental group(P>0.05).ConclusionLaryngeal mask combined with nerve block can be safely and feasible used for thoracoscopy surgery under spontaneous breathing general anesthesia.Compared with traditional double-lumen bronchial intubation general anesthesia,it has certain advantages in rapid recovery after surgery SPB can significantly prolong postoperative analgesic time and reduce the total amount of opioids.