Analgesia Effect Of Nalbuphine Combined With Ropivacaine For Thoracic Paravertebral Block In Thoracoscopic Surgery With Spontaneous Breathing

Objective: To observe the effect of nalbuphine as local anesthetic adjuvant in thoracic paravertebral nerve block(TPVB).Methods: From May 2019 to July 2020,80 patients were prepared for thoracoscopic surgery with spontaneous breathing,They were randomly divided into ropivacaine + nalbuphine group(Group LN)and ropivacaine group(group L).Group L and group LN received thoracic paravertebral nerve block before induction.Group LN received 0.33% ropivacaine 20 ml + 0.2mg/kg nalbuphine and group L received 0.33%ropivacaine 20 ml + saline.Anesthesia procedure is the same in the two groups,both groups started intravenous analgesia pump at the end of operation.The main outcome measures were Sp O2,ETCO2,HR and MAP at entering the operating room(T0),at the beginning of skin incision(T1),30 minutes after operation(T2)and at the end of skin suture(T3).After 2 hours,4 hours,8 hours,12 hours,24 hours record when resting and cough in patients with visual analogue scale(VAS)pain.propofol and Remifentanil were recorded.consumption,The time of first analgesia pump self-control key and the total times of analgesia pump pressing in 24 hours after surgery.The opioid drugs adverse reactions were recorded within 24 hours after surgery.Results: The observation results of 75 patients were included in the final statistical analysis(n = 38 in group L,n = 37 in group LN).The general basic information have no obvious difference between group L and group LN(all P > 0.05);About the heart rate,mean arterial pressure,blood oxygen saturation and breathe out carbon dioxide,there is not observed significant difference in two group(P > 0.05),Compare with LN,The use of Propofol and Remifentanil in L group was higher(P < 0.05);L group first press the analgesia pump control keys shorter than LN group(P < 0.05),postoperative analgesia pump control total times within 24 h L group were significantly higher than LN;Compared with LN group,at rest the VAS score of L group was higher at 2 h,4 h and 8 h after operation(P < 0.01);When coughing,the VAS score of L group was higher than that of LN group at 2 h,4 h and 8 h after operation(P <0.01),However,there was no obvious difference in VAS scores at rest and coughing 12 hours and 24 hours after operation(P > 0.01),and there was no significant difference in the occurrence of opioid adverse reactions within 24 hours after operation between the two groups(P > 0.05).Conclusion: TPVB combined with ropivacaine and nalbuphine can extend the perioperative analgesia time and enhance the analgesic effect of thoracoscopic surgery without intubation,and reduce the dosage of intravenous anesthesia.