Comparison of stress response and postoperative analgesia of ultrasound-guided paravertebral block and erect spinae plane block in patients undergoing video-assisted thoracic surgery

doi:10.11958/20222027

Abstract

Abstract:

Objective To evaluate the effects of ultrasus-guided thoracic paravertebral nerve block (TPVB) and erectile spinal-plane block (ESPB) on perioperative stress response and analgesia in patients undergoing thoracoscopic surgery. Methods Ninety patients underwent thoracoscopic surgery under elective general anesthesia were included and randomly divided into the control group (group C), the ESPB group (group E) and the TPVB group (group T), with 30 cases in each group. Before anesthesia induction, no treatment was given to the group C, and the group E and the group T were treated with ultrasound guided ESPB and TPVB on the affected side, and injected with 20 mL of 0.5% ropivacaine. Patient controlled analgesia (PCIA) was connected after operation. The venous blood samples were collected immediately before operation (T₀), 30 minutes after operation (T₁) and at the time of tracheal catheter removal (T₂) to test the concentration of blood glucose (Glu) and serum cortisol (Cor). The type of surgery, the duration time of surgery, the number of patients who needed to use phenylephrine and the amount of remifentanil for hypotension during operation were recorded. Visual analog scores (VAS) of patients at rest and coughing status at T₂, 12 hours after operation (T₃), 24 hours after operation (T₄), 48 hours after operation (T₅), the total number of PCIA compression and the total amount of PCIA sufentanil infusion within 48 hours after operation, the use of rescue analgesia, and the occurrence of adverse reactions were recorded. Results Compared with T₀, concentrations of Cor and Glu at T₁ and T₂, were increased in patients (P<0.05). Compared with the group C, Glu was significantly decreased in the group T, the resting VAS pain scores of T₂, T₃, T₄ and T₅ were decreased in the group T and the group E. The coughing VAS pain scores of T₂ and T₄ were decreased, and the intraoperative dosage of reifentanil, the number of PCIA compression and the total infusion of sufentanil were decreased. The remedial analgesic rate was decreased in the T group (P<0.05). Compared with the group T, the resting VAS scores of T₂, T₃ and T₄ were increased in the group E, and the coughing VAS scores of T₃ were increased, the number of PCIA compression, remifentanil usage and the total infusion of PCIA sufentanil were increased. The percentage of intraoperative use of norepinephrine for hypotension was decreased (P<0.05). Conclusion TPVB can inhibit the stress response of patients undergoing thoracoscopic surgery. TPVB could provide better postoperative analgesia than ESPB, and has a significant inhibitory effect on intraoperative blood pressure.

Key words: analgesia, thoracoscopes, stress, physiological, erector spinae plane block, thoracic paravertebral block

CLC Number:

R614

Figures/Tables 4

References 17

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组别		年龄/岁		性别（男/女）	BMI/（kg/m²）
C组		52.9±10.9		14/16	22.0±1.2
T组		49.7±10.9		10/20	21.5±1.4
E组		51.6±11.2		12/18	21.7±1.5
F或χ²		0.642		1.111	1.513
组别	ASA分级（Ⅰ/Ⅱ）		手术时间/min			肺部分切除术/ 肺叶切除术
C组	9/21		83.0（72.3，93.3）			20/10
T组	10/20		84.5（68.7，105.8）			18/12
E组	11/19		76.5（61.5，107.5）			16/14
χ²	0.300		1.024			1.111

组别		年龄/岁		性别（男/女）	BMI/（kg/m²）
C组		52.9±10.9		14/16	22.0±1.2
T组		49.7±10.9		10/20	21.5±1.4
E组		51.6±11.2		12/18	21.7±1.5
F或χ²		0.642		1.111	1.513
组别	ASA分级（Ⅰ/Ⅱ）		手术时间/min			肺部分切除术/ 肺叶切除术
C组	9/21		83.0（72.3，93.3）			20/10
T组	10/20		84.5（68.7，105.8）			18/12
E组	11/19		76.5（61.5，107.5）			16/14
χ²	0.300		1.024			1.111

组别	Cor/（nmol/L）
组别	T₀		T₁		T₂
C组	209.5±60.3		279.8±90.3^a		314.2±150.9^a
T组	178.7±100.3		257.4±74.4		286.0±115.7^a
E组	207.0±80.9		267.1±98.2^a		299.5±107.4^a
组别		Glu/（mmol/L）
组别		T₀		T₁		T₂
C组		4.6±1.0		6.1±0.7^a		7.2±2.0^a
T组		4.8±0.4		5.3±0.7^b		6.4±1.5^a
E组		5.0±0.7		5.9±1.3^a		6.8±1.6^a

组别	Cor/（nmol/L）
组别	T₀		T₁		T₂
C组	209.5±60.3		279.8±90.3^a		314.2±150.9^a
T组	178.7±100.3		257.4±74.4		286.0±115.7^a
E组	207.0±80.9		267.1±98.2^a		299.5±107.4^a
组别		Glu/（mmol/L）
组别		T₀		T₁		T₂
C组		4.6±1.0		6.1±0.7^a		7.2±2.0^a
T组		4.8±0.4		5.3±0.7^b		6.4±1.5^a
E组		5.0±0.7		5.9±1.3^a		6.8±1.6^a

组别	静息VAS评分/分
组别	T₂			T₃	T₄		T₅		F
C组	4.3±0.6			4.5±0.9	4.2±0.8		4.0±0.6		2.595
T组	2.0±0.5^a			2.5±0.6^a	2.6±0.7^a		2.8±0.8^a		8.065^＊＊
E组	3.3±0.7^ab			3.7±0.6^ab	3.2±0.5^ab		3.1±0.7^a		7.148^＊＊
F	106.986^＊＊			68.817^＊＊	42.585^＊＊		22.858^＊＊
组别		咳嗽VAS评分/分
组别		T₂	T₃			T₄	T₅	F
C组		5.5±0.8	5.2±0.7			4.8±1.0	4.5±1.1	6.848^＊＊
T组		3.5±1.3^a	3.3±1.5^a			3.8±1.0^a	3.4±1.2^a	0.775
E组		3.8±1.5^a	4.5±1.4^b			4.0±1.2^a	3.8±1.2	1.315
F		24.894^＊＊	18.670^＊＊			6.602^＊＊	6.705^＊＊