Effects of general anesthesia combined with thoracic paravertebral nerve block on postoperative analgesia and pulmonary infection in patients with lung cancer surgery

doi:10.11958/20221629

Abstract

Abstract:

Objective To investigate the effect of general anesthesia (GA) combined with thoracic paravertebral nerve block (TPVB) on postoperative analgesia and pulmonary infection in patients undergoing lung cancer surgery. Methods A total of 170 lung cancer patients who underwent thoracoscopic lung lobectomy were divided into the GA group (80 cases) and the GA combined with TPVB group (90 cases) according to the anesthetic regimen. Intraoperative dosage of anesthetics, postoperative pressing times of analgesic pump, diastolic blood pressure (DBP), systolic blood pressure (SBP) and heart rate (HR) before anesthesia induction, after anesthesia induction and after operation, and pain (VAS) score within 48 h after operation were compared between the two groups. The levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and interleukin-8 (IL-8) were measured by enzyme-related immunosorbent assay before and after surgery in the two groups. The postoperative recovery time and the incidence rates of pulmonary infection and adverse anesthesia reactions were compared between the groups. Results The dosages of remifentanil, propofol and the total pressing times were lower in the GA combined with TPVB group than those in the GA group (P<0.05). DBP, SBP and HR after anesthesia induction and after operation were higher in the GA combined with TPVB group than those of the GA group (P<0.05). The VAS scores at 4, 8, 12, 24 and 48 h after operation were lower in the GA combined with TPVB group than those of the GA group (P<0.05). After operation, levels of IL-6, TNF-α and IL-8 were lower in the GA combined with TPVB group than those in the GA group (P<0.05). The recovery time of spontaneous breathing, extubation time, length of stay in recovery room, postoperative first ambulation time and hospital stay were shorter in the GA combined with TPVB group than those of the GA group (P<0.05). The incidence rates of postoperative pulmonary infection and adverse anesthesia reactions were lower in the GA combined with TPVB group than those in the GA group (P<0.05). Conclusion GA combined with TPVB can achieve good analgesic effect on patients undergoing lung cancer surgery and reduce the incidence of postoperative pulmonary infection.

Key words: lung neoplasms, nerve block, thoracic vertebrae, anesthesia, general, postoperative analgesia, pulmonary infection

CLC Number:

R734.2，R614.2

Figures/Tables 7

References 22

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组别		n	性别（男/女）			年龄（岁）
GA组		80	31/49			58.61±13.12
联合组		90	43/47			59.47±10.66
χ²或t			1.404			0.468
组别	BMI（kg/m²）			病理分型			临床分期
组别	BMI（kg/m²）			鳞癌	腺癌		Ⅰ期	Ⅱ期
GA组	24.25±3.33			23	57		47	33
联合组	24.22±2.35			22	68		59	31
χ²或t	0.081			0.403			0.836

组别		n	性别（男/女）			年龄（岁）
GA组		80	31/49			58.61±13.12
联合组		90	43/47			59.47±10.66
χ²或t			1.404			0.468
组别	BMI（kg/m²）			病理分型			临床分期
组别	BMI（kg/m²）			鳞癌	腺癌		Ⅰ期	Ⅱ期
GA组	24.25±3.33			23	57		47	33
联合组	24.22±2.35			22	68		59	31
χ²或t	0.081			0.403			0.836

组别	n	瑞芬太尼用量（mg）	丙泊酚用量（mg）	镇痛泵按压次数（次）
GA组	80	1.61±0.20	507.93±32.57	11.50±0.78
联合组	90	1.32±0.18	343.44±34.38	6.14±0.61
t		10.021^＊＊	31.914^＊＊	49.449^＊＊

组别	n	瑞芬太尼用量（mg）	丙泊酚用量（mg）	镇痛泵按压次数（次）
GA组	80	1.61±0.20	507.93±32.57	11.50±0.78
联合组	90	1.32±0.18	343.44±34.38	6.14±0.61
t		10.021^＊＊	31.914^＊＊	49.449^＊＊

组别	n	DBP（mmHg）			SBP（mmHg）			HR（次/min）
组别	n	麻醉诱导前	麻醉诱导后	术毕	麻醉诱导前	麻醉诱导后	术毕	麻醉诱导前	麻醉诱导后	术毕
GA组	80	85.30±5.90	77.59±7.54^a	79.53±5.86^a	121.84±8.53	107.24±7.59^a	112.06±10.03^ab	82.04±6.39	73.94±5.93^a	76.23±6.09^ab
联合组	90	86.14±5.48	82.28±5.04^a	83.38±5.19^a	119.52±8.56	115.86±8.42^a	117.46±10.69^a	82.99±5.92	79.62±5.83^a	79.88±5.28^a
t		0.968	4.710^＊＊	4.549^＊＊	1.763	6.976^＊＊	3.379^＊＊	1.008	7.443^＊＊	4.188^＊＊