| Objectives To explore the analgesic effect of dezocine combined with ropivacaine used in thoracic paravertebral block(TPVB)during the patients underwent video-assisted thoracoscopic lobectomy and its influence on postoperative recovery.Methods 93 patients who underwent video-assisted thoracoscopic lobectomy were selected as the research objects in our hospital(the Affiliated Hospital of North China University of Technology).The 93 patients were randomly divided into 3 groups: dezocine combined with ropivacaine TPVB combined with general anesthesia group(D group),ropivacaine TPVB combined with general anesthesia group(R group)and general anesthesia group(G group).Expect G group,the D group and R group were underwent TPVB after general anesthesia induction.Both R group and D group were treated with0.375% ropivacaine when TPVB was applied,at the same time 0.1mg/kg dezocine was added to D group.The vital signs of the three groups of patients at diverse times: before anesthesia(T0),5 minutes before skin incision(T1),5 minutes after skin incision(T2),and leaving the operating room(T3)were measured and recorded.Recorded intraoperative anesthesia dosage,thoracic paravertebral block related complications,and quantity of nerve block segment after surgery.Postoperative VAS pain score,the frequency of analgesia pump pressed within 48 hours after operation,remedial analgesic,and postoperative analgesic adverse reactions were used to evaluate postoperative analgesia.40 recovery quality rating scale was used to evaluate quality of postoperative recovery at 1day before surgery(Ta),1 day after surgery(Tb)and 1 month after surgery(Tc).Postoperative complications,the time to resume eating,the time to get out of bed for the first time,the time to remove thoracic closed drainage tube,and the length of hospitalization time after surgery among the 3 groups were recorded.Results 1 Analyses between groups showed that there were no statistically significant difference between the three groups for gender,age,BMI,ASA and operation time(P>0.05).2 Analyses between groups showed that there were no statistically significant difference between the three groups for MAP and HR in T0 and T1(P>0.05).Analyses between group D and R showed that there were no statistically significant for MAP and HR in T2 and T3(P>0.05).The measure of MAP and HR at T2 and T3 time in D group and R group were lower than those in G group,and the difference was statistically significant(P<0.05).Analyses at the same group showed that there were statistically no significant difference both D group and R group for MAP and HR from T0 to T3(P>0.05).Each group had no significantl difference at each time point(P>0.05).3 The dosage of Intraoperative anesthesia in C group was more than that R group was more than that in RD group,the difference was statistically significant(P<0.05).There were no significant difference in thoracic paravertebral block related complications,and and quantity of nerve block segment after surgery between the RD group and the R group(P>0.05).4 The VAS score of patients in G group(6h 2.57±0.50、12h 3.97±0.56 and 24 h 3.83±0.65)was significantly higher than those in D group(6h 1.70±0.70,12 h 2.63±0.49 and24 h 2.87±0.4)and R group(6h 2.17±0.59,12h 3.07±0.5 and 24h 3.07±0.58)within 24 hours after VATS(P<0.05).Analyses between groups showed that there were statistically significant difference between R group and D group for the VAS score of patients within12 hours after VATS(P<0.05).Analyses between groups showed that there were no statistically significant difference between the three groups for the VAS score of patients at48 hours after VATS(P>0.05).Compared with G group(5.53±0.86),the VAS score of the D group(4.47±0.57)and R group(4.86±0.73)were significantly decreased at the time when the patients felt the most pain(P<0.05).Analyses between groups showed that there were statistically significant difference between R group and D group for the VAS score of patients when the patients felt the most pain(P<0.05).Compared with G group respectively,the times of analgesia pump pressed(within 48 hours after VATS)and the number of remedial analgesic were significantly higher than that of the D group and than that of the R group(P<0.05).In R group,the number of patients pressed analgesia pump and the number of remedial analgesic were significantly higher than that in D group,the difference was statistically significant(P < 0.05).In the comparison of postoperative nausea and vomiting(PONV),the D group(5)and the R group(4)were significantly lower than that the G group(10),and the difference was statistically significant(P<0.05).Analyses between groups showed that there were no statistically significant difference between the D group and the R group for PONV(P>0.05).5 Compared with group G,the time of recover to eat,the time of walking at the first time,the time of indwelling the thoracic closed drainage tube,and the length of hospitalization time after surgery hospital stay after surgery in the D group and the R group were significantly shortened,and the Qo R-40 score were significantly impoved.The difference was statistically significant(P<0.05).Compared with the R group,the D group had shorter time to resume eating,shorter time to walk at the first time,and shorter time to remove the thoracic closed drainage tube,and the Qo R-40 score was higher.The difference was statistically significant(P<0.05).No complications such as lung infection,atelectasis,respiratory failure and arrhythmia occurred in the three groups of patients.Conclusions In Video-assisted thoracoscopic lobectomy,dezocine combined with ropivacaine for TPVB has better analgesic effects than ropivacaine alone for TPVB.It significantly shortens the time of recover to eat,the time of walking at the first time,the time of indwelling the thoracic closed drainage tube,which promotes the recovery of patients.Figure 5;Table 9;Reference 100... |
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