The Effect Evaluation Of Paravertebral Nerve Block, Parecoxib And Flurbiprofen Axetil After Thoracotomy

Objective:To observe whether ultrasound-guided paravertebral nerve block with ropivacaine0.25%can relief the acute and chronic pain after thoracotomy, and compare its analgesic effect withparecoxib/flurbiprofen, and observe whether the three methods can reduce the drugconsumption of PCAMethods:One hundred and twenty patients(ASAⅠ-Ⅲ) who will receive elective thoracotomysurgery were randomly divided into four groups: ultrasound-guided paravertebral nerveblock with ropivacaine0.25%group(group N, n=30), parecoxib sodium group(group T,n=30), flurbiprofen group(group K, n=30), control group(group C, n=30). The drugsadministration and the postoperative follow-up was done by different researchers.Group N: ultrasound-guided paravertebral nerve block was done after completion ofsurgery and before patient waking up, and injected ropivacaine0.25%10ml through theneedle in T4and T8levels respectively, group T: parecoxib sodium40mg(diluted to5mlwith normal saline) was intravenously administered just0.5h before the completion ofsurgery, group K: flurbiprofen50mg was intravenously administered just0.5h before thecompletion of surgery, group C: normal saline5ml was intravenously administered just0.5h before the completion of surgery. Patients of the four groups were all receivedpatient-controlled analgesia with intravenous sufentanil immediately when they were awake.A visual analogue scale was used to assess pain at rest and on coughing, the VASpain scores、vital signs、drug consumptions and press numbers of PCA、side effects of apioidat1h、4h、16h、24h、28h、48h postoperatively were recorded, restlessness or not and theresidence time in PACU were recorded, the incidence of chronic pain and its influence of thequality of life were investigated by telephone interview at the sixth month after thoracotomy.Results:1. The vital signs of every group at1h、4h、16h、24h、48h postoperatively weresimilar(P>0.05).2. The resting and motion VAS pain scores of group N、group T and group K at everyfollowing times were significantly lower than the scores of group C(P<0.05).3. The VAS pain scores of group N at1h、4h postoperatively were significantly lowerthan those of group T and group K(P<0.05), and the VAS pain scores at the otherfollowing times were similar(P>0.05).4. The drug consumptions and press numbers of PCA of group N、group T and groupK at every following times were significantly lower than those of group C(P<0.05),there were no significant differences among group N、group T and group K of thedrug consumptions and press numbers of PCA(P>0.05).5. The residence time in PACU of the four groups were similar(P>0.05), The rates ofrestlessness of group T and group K were significantly lower than those of group Nand group C(P<0.05).6. There were no significant differences among group N、group T、group K of the sideeffects of opioid(P>0.05), but the side effects of apioid of the above three groupwere lower than those of group C.7. At the sixth month after thoracotomy, the incidence of chronic pain of group N wassignificantly lower than that of group C(P<0.05), although the incidences of chronic pain of group T and group K were lower than that of group C, there wereno significant differences(P>0.05), the incidences of chronic pain of group N、group T、group K were similar(P>0.05).Conclusion:Ultrasound-guided paravertebral nerve block with ropivacaine0.25%can significantlyreduce the post-thoracotomy pain, its function in controlling the acute pain within4hoursafter thoracotomy is better than parecoxib and flurbiprofen, and three methods can all get asatisfactory analgesic effect and can reduce the incidences of chronic pain, decrease Thedrug consumptions and press numbers of PCA and the side effects of apioid.