Application Of General Anesthesia Combined With Ultrasound-guided Paravertebral Nerve Block In Patients Undergoing Thoracoscopic And Laparoscopic Esophagectomy

ObjectiveEsophageal cancer is one of the malignant tumors with the highest incidence in China,and the mortality rate ranks the fourth among cancer deaths in China.The traditional thoracotomy for esophageal cancer radical surgery takes a long time and causes great trauma.Perioperative anesthesia management is relatively difficult,and postoperative analgesia is often insufficient,leading to postoperative pain,difficulty in expectoration,limited mobility and other related complications.In recent years,Thoracoscopic and Laparoscopic Esophagectomy(TLE)has been widely used,and the incidence of severe trauma and postoperative complications is significantly reduced,but postoperative pain is still moderate to severe.Meanwhile,Postoperative Cognitive Dysfunction(POCD)may occur in patients with esophageal cancer after surgery,which will seriously affect the patients’rapid recovery after surgery(Enhanced Recovery After Surgery,ERAS).Ultrasound-Guided Paravertebral Nerve Block(USG-PVB)is recommended for thoracic surgery anesthesia and analgesia with accurate positioning and high safety,clear analgesic effect and less adverse reactions.This study is to investigate the application of general anesthesia combined with ultrasound-guided paravertebral nerve block(USG-PVB)for thoracoscopic and laparoscopic esophagectomy(TLE),whether it can provide good analgesic effect and reduce perioperative opioid doses,improve early postoperative pain,agitation and postoperative cognitive function,shorten postoperative hospitalization time,and promote rapid recovery after surgery.Methods Forty-eight patients accepted thoracoscopic and laparoscopic esophagectomy,40 males and 8 females,aged 52-72 years,BMI 15.1-26.2kg/m~2,ASA physical statusⅠ~Ⅱ,were recruited and randomly divided into general anesthesia group(group G,n=24)and general anesthesia combined with ultrasound-guided paravertebral nerve block group(group P,n=24).Both group P and group G received the same general anesthesia.Patients in group P received paravertebral nerve block guided by ultrasound before anesthesia induction.Medication including anesthetics and vasoactive agents in operating room and in PACU were calculated.Extubation time,PACU residence time,restlessness in PACU and VAS(visual analogue scale)in quiet and coughing conditions in analepsia,lefting PACU and 1,2,3,5d after operation were recorded.The mini-mental state examination(MMSE)scores of patients 1d before surgery and 7d after surgery were measured.The length of postoperative hospitalization and the incidence of postoperative cognitive disfunction(POCD)were recorded.Results(1)General clinical data:there was no significant difference(P>0.05)between two groups on gender,age,BMI,ASA classification,education level,preoperative complications;(2)Medication including anesthetics and vasoactive agents during surgery:compared to group G,the intraoperative consumption of propofol,remifentanil and sulfentanyl were significantly decreased in group P,and the consumption of phenylephrine was remarkably higher in group P(P<0.05).There was no significant difference in ephedrine and nicardipine dosage between the two groups(P>0.05).(3)Intraoperative and postoperative conditions:compared with group G,the extubation time,the incidence of PACU agitation,the dosage of sufentanil used in PACU,the PACU stay time and length of postoperative hospitalization were significantly reduced in group P(P<0.01 or P<0.05).There was no significant difference in the duration of one-lung ventilation and operation between the two groups(P>0.05).(4)The VAS scores at different time points under different conditions:compared with group G,the VAS scores in quiet and coughing conditions in analepsia,lefting PACU and 1,2,5d after operation and the VAS scores in coughing conditions in 3d after operation were remarkably decreased in group P(P<0.01 or P<0.05).(5)MMSE scores and POCD:Compared with 1d before surgery,the MMSE score of group G was significantly decreased on 7d after surgery(P<0.05).There were 2 cases(8.3%)of POCD in the group P and 6 cases(25.0%)in the group G 7 d after surgery,with no statistically significant difference in the incidence of POCD between the two groups(P>0.05).ConclusionThe general anesthesia combined with ultrasound-guided paravertebral nerve block(USG-PVB)can effectively reduce the consumption of perioperative opioid analgesic drugs,relieve the early postoperative pain and agitation of the patients undergoing thoracoscopic and laparoscopic esophagectomy(TLE),and shorten the hospital stay,thus facilitating the postoperative recovery.