Effect Of SAPB And TPVB On Postoperative Pain In Patients With Single-port Thoracoscopic Lobectomy

BackgroundThoracoscopy has small incision,less bleeding,clear vision and quick recovery,but there is still moderate to severe pain after thoracoscopic surgery.Severe pain can cause complications such as atelectasis and lung infection,reducing patient satisfaction.Epidural analgesia(EDA)and thoracic paravertebral block(TPVB)are common methods of analgesia after thoracoscopic surgery,but epidural block often has severe hypotension and epidural hematoma.thoracic paravertebral nerve block may have complications such as pneumothorax and hematoma at the puncture site.Anterior serratus plane block(SAPB)is a superficial fascia plane block,easy to learn,less complications,and analgesic effect in the analgesia after thoracoscopic surgery.ObjectiveTo compare the analgesic effect of ultrasound-guided anterior serratus plane block and thoracic paravertebral nerve block combined with intravenous analgesia in patients with single-port thoracoscopic lobectomy.MethodsFifty patients with early stage lung cancer undergoing thoracoscopic lobectomy were randomly assigned to the anterior serratus plane block group(SAPB group)and the thoracic paravertebral nerve block group(TPVB group),25 cases in each group,Nervous block before induction of anesthesia,The complications of the two groups of nerve block operations were recorded separately,and the block range was evaluated after 30 minutes.After entering the room,routine monitoring was performed and the arterial puncture was performed under local anesthesia.The induction was induced by total intravenous anesthesia.Before the induction,Fully oxygenated nitrogen before induction,After the patient’s consciousness disappeared and the muscles were loosened,the double-lumen endotracheal tube was intubated under the guidance of fiberoptic bronchoscopy.The ventilator is connected,and after internal disinfection,the internal jugular vein is placed and the anesthesia is maintained as an intravenous anesthesia.The average arterial pressure and heart rate were recorded in the room for 5 min,immediate incision,artificial pneumothorax for 3 min,artificial pneumothorax for 1 h,and 5 min after extubation.The operation time,the total dose of remifentanil and the use of perioperative vasoactive drugs were recorded.The postoperative analgesics were given before the end of the operation,and the patient-controlled intravenous analgesia pump was connected.The visual analog scores(VAS)of resting and coughing at 1h,4h,6h,12 h,and 24 h after surgery,the number of compressions of the electronic analgesia pump,and the total dose of sufentanil at 24 h after surgery were followed up.The total dose of sufentanil at 24 hours after surgery,whether it was remedial analgesia after surgery,patient satisfaction,postoperative nausea,vomiting,dizziness and drowsiness.ResultsThere were no significant differences in the demographics of gender,age,height and weight between the two groups,and the p values were all greater than 0.05;In the thoracic paravertebral nerve block group,four patients developed hematoma at the puncture site during operation,and the anterior serratus plane block group had no complications during operation;There was no significant difference in the range of nerve block between the two groups,p=0.197,p>0.05;there was no difference in mean arterial pressure and heart rate between the two groups at each time point.p>0.05,both nerve blocks can maintain the smooth hemodynamics during operation;there was no difference between the two groups in operation time,p=0.215;the doses of remifentanil in the two groups were comparable,SAPB The group had remifentanil(1.384±0.236)mg and TPVB group(1.332±0.255)mg,p>0.05,which was not statistically significant.There were statistics between the vas scores at the resting point and the VAS score at the time of coughing.There was no difference in vas scores between the two groups at each time point;there was no difference in postoperative electronic analgesia pump pressure between the two groups,postoperative sufentanil dosage,SAPB group(75.64 ± 1.279)ug and TPVB Group(75.66±0.231)ug,p>0.05,no statistics differences.There was no difference in postoperative remedial analgesia,postoperative satisfaction,nausea and vomiting between the two groups.ConclusionsUltrasound-guided anterior serratus plane block and thoracic paravertebral nerve block combined with intravenous analgesia can meet postoperative analgesia in singleport thoracoscopic surgery,both of which can maintain intraoperative hemodynamic stability.Compared with the thoracic paravertebral nerve block,the anterior serratus plane block operation is simple and easy to learn,with fewer complications,and the anterior serratus plane block is more advantageous.