Study On Different Puncture Methods Of Ultrasound-guided Thoracic Paravertebral Block

Objective: By studying two commonly used methods of thoracic paravertebral nerve block:parasagittal approach out-of-plane technique and transverse intercostal approach in-plane technique.Compare difference of the two groups in the needle body display score,puncture time,skin costal transverse process distance,paravertebral space expansion distance,diffusion depth after injection,block ranges of 15 minutes and 30 minutes,the difference in the incidence of puncture complications,VAS score after awake and patient satisfaction.In order to further evaluate the reliability and feasibility of the two paravertebral nerve block approaches under ultrasound guidance.Methods: 129 patients who underwent chest surgery in our hospital from September 2019 to April 2020,were randomly divided into ultrasound-guided parasagittal approach out-of-plane technique group(P group)and transverse intercostal approach in-plane technique group(M group).Observe and compare the two groups of needle body display scores,puncture time,number of needle insertions,15 minutes after injection,the range of blocked segments and the range of blocked segments after 30 minutes,ultrasound measurement before injection,ultrasound measurement after injection,whether there are complications of puncture,VAS score after awake and patient satisfaction.Results:(1)General data of the two groups: the two groups of patients are baseline balanced and comparable in age,gender,weight,height,and surgical procedures.129 patients successfully completed anesthesia and surgery,and no one withdrew.(2)Comparison of needle body display score,puncture time and frequency: needle body display score and puncture time: the score of the M group(1.60±0.5)is higher than that of the P group(0.31±0.59)(P<0.01).The results of puncture time and number of injections were similar between the two groups.(3)Comparison of ultrasonic measurements before and after drug injection: The distance between the transverse processes of the skin before and after the ultrasound measurement was(2.49±0.45,2.50±0.46)cm,and the distance between the paravertebral spaces was(0.43±0.18,0.39±0.14)cm.Among them,the distance of the diffusion depth of paraveraginal space measured by ultrasound after injection in group M was(0.82±0.24)cm higher than that in group P(0.69±0.23)cm.M group and P group compare the paravertebral space before and after injection were obviously different(P<0.01).(4)The block range of 15 min after the injection of the M group was 4(2,5),and the block range of the P group was 4(2,6);the range of block in group M was 4(3,5)after 30 min of drug injection,the range of block in group P was 6(4,7)after 30 min of drug injection,and the range of block in group P was greater than group M(P<0.01).In addition,in group P,the effect after 30 min of medium injection was higher than that after 15 min,while in group M there was no difference.(5)The VAS scores of the two groups postoperative were similar at 2 hours and 6 hours,but at 24 hours of postoperative,VAS scores of group P 4(3,5)were higher than group M 3(2,4),(P<0.01);but there was no significant difference in patient satisfaction between group M and Group P.(6)Comparison of the incidence of puncture complications: although the incidence of complications in group M was lower than that in group P(4.5%<8.1%,P>0.05),the incidence of hematoma at the puncture site in group P was 8.1% higher than that in group M 3.0%(P>0.05).Conclusion: The two approaches have a high success rate under ultrasound guidance.Among them,The transverse intercostal approach in plane was superior to the lateral sagittal approach in needle body display score,paravertovertebral space diffusion depth after injection,postoperative maintenance analgesia and lower incidence of hematoma.Therefore,the transverse intercostal approach in plane technique may be more advantageous for thoracic paravertebral nerve block under ultrasound.