Effect Of Thoracic Paravertebral Nerve Block On Stress Hormone Levels In Patients Undergoing Thoracotomy

backgroundChest surgery has a long time,large damage,severe postoperative pain,and severe stress response will bring severe hemodynamic changes and internal environment disorders to the body.Thoracic paravertebral nerve block not only blocks the sympathetic nerve associated with surgery,but also blocks the centripetal conduction of somatosensory nerves at the surgical site,thereby reducing sympathetic tone and significantly reducing the perioperative stress response in patients.Maintain hemodynamic stability and reduce complications.ObjectivesThis study investigated the effects of thoracic paravertebral nerve block on the levels of norepinephrine,cortisol,and adrenocorticotropic hormone in patients undergoing thoracotomy.To investigate whether general anesthesia combined with paravertebral nerve block can inhibit the secretion of stress hormones in patients undergoing thoracotomy,whether to reduce the amount of general anesthetics and evaluate the postoperative analgesic effect,and select appropriate for patients undergoing thoracotomy The anesthesia method provides a theoretical basis.MethodsSeventy patients undergoing thoracotomy were divided into two groups:control group A（control group）and observation group B（observation group B）.According to the exclusion criteria,16 patients were excluded,28 patients in group A and 26 patients in group B.Group A:double lumen bronchial intubation general anesthesia group,group B:double lumen bronchial intubation general anesthesia and paravertebral nerve block group,group B all patients had unilateral paravertebralnerve block before induction of general anesthesia.The vital signs of the two groups were stable after entering the room,the induction of general anesthesia was the same,the intraoperative use of intravenous inhalation combined with general anesthesia was used to maintain the fluctuation of heart rate and blood pressure at about 25%of the preoperative basic value.Patients in both groups were treated with intravenous analgesia pump after operation.Blood samples were taken before anesthesia induction（before paravertebral nerve block）（T1）,tracheal intubation（T2）,operation 1 h（T3）,operation 2 h（T4）,and after operation（T5）,respectively.The concentrations of noradrenaline,cortisol and adrenocorticotropic hormone were detected.The mean arterial pressure and heart rate were recorded in both groups before anesthesia induction（T1）,tracheal intubation（T2）,1 hour operation（T3）,2hours after operation（T4）,and at the end of operation（T5）.The dosage of sufentanil during operation was recorded in both groups.Visual analogue score（VAS）was used to evaluate the analgesic scores in 6 hours,12 hours and 24 hours after operation.Press times of analgesic pump at 6 hours and 12 hours and 24 hours after operation.The incidence of postoperative nausea,vomiting and respiratory inhibition in the two groups was recorded.Results1.There was no significant difference in general data between the two groups（P>0.05）.2.There was no significant difference in the concentration of noradrenaline（NE）,cortisol（COR）,adrenocorticotropin（ACTH）between group B and group A at（T₁）time point（P>0.05）,but at tracheal intubation（T₂）,The time points of operation 1 hour（T₃）,2hours（T4）,and post-operation（T5）in group B were significantly lower than those in group A（P<0.05）.3.The mean arterial pressure and heart rate in group B were significantly lower than those in group A at tracheal intubation（T₂）,operation 1 hour（T₃）,operation 2hours（T₄）,and postoperative time point（T₅）（P<0.05）.4.Compared with group A,the dosage of sufentanil in group B was significantly lower than that in group A（P<0.05）.5.Compared with group A,the VAS scores in group B were significantly lower than those in group A（P<0.05）.6.Compared with group A,the number of analgesic pump in group B was significantly lower than that in group A（P<0.05）.7.The incidence of postoperative nausea and vomiting and respiratory inhibition in group B was significantly lower than that in group A（P<0.05）.Conclusion1.Thoracic paravertebral nerve block alleviates stress response and inhibits hormone secretion of NE,COR and ACTH in patients undergoing thoracotomy.2.Thoracic paravertebral nerve block reduces the dosage of sufentanil during thoracotomy and increases the analgesic effect after thoracotomy.3.Thoracic paravertebral nerve block reduced the incidence of postoperative nausea,vomiting and respiratory inhibition in patients undergoing thoracotomy.