Effect Of Thoracic Paravertebral Block And Erector Spinae Plane Block On Postoperative Pain In Patients Undergoing Combined Thoracoscopic-laparoscopic Radical Resection Of Esophageal Carcinoma

Objective: Surgery is the main treatment method of esophageal cancer,which posing a serious threat to people’s health is one of the most common malignant tumors in the world.Patients often suffer severe acute postoperative pain after radical resection of esophageal carcinoma.Chronic postoperative pain(CPOP)is also a morbidity of high incidence.This study intends to apply erector spinae plane block(ESPB)and thoracic paravertebral block(TPVB)in patients undergoing combined thoracoscopic-laparoscopic radical resection of esophageal carcinoma to observe the effects on postoperative acute pain and postoperative chronic pain of erector spinal plane block and thoracic paravertebral nerve block,providing a reference for the clinical application of erector spinal plane block and thoracic paravertebral nerve block.Methods: one hundred and thirty-eight patients undergoing combined thoracoscopic-laparoscopic radical resection of esophageal carcinoma from the First Affiliated Hospital of University of Science and Technology of China were selected.Inclusion criteria: combined thoracoscopic-laparoscopic radical resection of esophageal carcinoma in upper abdominal and right thoracic approach(IVOR-LEWIS)or combined thoracoscopic-laparoscopic radical resection of esophageal carcinoma in left cervical,right thoracic and upper abdominal approach(Mc Keown);aged from sixty five toeighty two years old;American Society of Anesthesiologist(ASA)physical status II to III.Exclusion criteria: failure of thoracic paravertebral block or erector spinae plane block;local anesthetic allergy or toxicity;spinal deformity;local infection around the puncture site;mental illness and other reasons resulting in inability to cooperate or communicate;serious systemic disease controlled poorly;entered ICU after surgery;died or underwent reoperation within 3 months after surgery;dropped out or lost to follow-up.Using a website random number generator(www.qinms.com),all patients were randomly divided into three groups: thoracic paravertebral block group(group T,n=46),erector spinae plane block group(group E,n=46),and control group(group C,n=46).Patients in group T received ultrasound-guided TPVB at the right T5-6 level before induction of anesthesia.Patients in group E received ultrasound-guided ESPB at the right T5 level before induction of anesthesia.Patients in group C received no nerve block before induction of anesthesia.All patients received bilateral ultrasound-guided subcostal transversus abdominis plane block after induction of anesthesia and received patient-controlled intravenous analgesia after surgery.Intraoperative dosage of propofol and remifentanil,postoperative extubation time,the time to first patient-controlled intravenous analgesia,times of patient-controlled intravenous analgesia administration,postoperative pentazocine addition times,the time to first postoperative ambulation,the incidence of postoperative nausea and vomiting and itchy skin within 48 hours,VAS pain score at rest and while coughing 10 minutes after extubation,4 hours,1 day,2 days,and 3 days after the operation,postoperative complications and the incidence of chronic pain 3 months after surgery were recorded.Those with score of ≧3 on the single item of average pain in the brief pain inventory(BPI)were labeled as patients with postoperative chronic pain.Results: Compared with group C,the dosage of propofol and remifentanil was lower in group T and E,the time to postoperative extubation and first ambulation was shortened,meanwhile the time to first patient-controlled analgesia(PCA)was prolonged,the times of PCA administration and supplemental pentazocine was reduced(P<0.05).Compared with group E,the dosage of remifentanil was less in group T,and the time to first postoperative ambulation was shortened(P<0.05).Postoperative pain score in group T and group E were lower than that in group C within 1 day after surgery(P<0.017),excepted that the score while coughing in group E was similar as that in group C 10 minutes after extubation(P>0.017).The pain score 1 day after surgery and that score while coughing 4 hours after surgery in group T were lower than that in group E(P<0.017).There was no statistical significance in the incidence of postoperative complications among the three groups(P>0.05).The incidence of CPOP in group C was higher than that in group T(P<0.017).There was no significant difference in the average pain score of BPI 3 months after surgery among the three groups(P>0.05).Conclusion: ESPB and TPVB provided perioperative analgesia for patients undergoing combined thoracoscopic-laparoscopic radical resection of esophageal carcinoma,while TPVB has a better effect.TPVB reduced the incidence of CPOP.