Ultrasound-guided Serratus Plane Block And Paravertebral Nerve Block Were Used For The Comparison Of Postoperative Analgesia In Thoracoscopic Lobectomy

Objective:Comparing with ultrasound-assisted thoracic paravertebral nerve block,the clinical study of perioperative analgesic effect of ultrasound-assisted planar anterior serration block was used during thoracoscopic surgery.Methods:Sixty patients（approved by the ethics committee）planned to undergo thoracoscopic lobectomy in the first affiliated hospital of nanchang university were selected and randomly divided into two groups:ultrasound-assisted thoracic paravertebral nerve block group（TPVB group）and ultrasound-assisted anterior serratus muscle plane block group（SPB group）,30 patients in each group.After enter the operating room Intravenous infusion dexmedetomidine hydrochloride each patient of the two groups,followed by ultrasound-guided nerve block according to the surgical area.The local anestheticwas 0.33%ropivacaine 20ml in the two groups,the SPB group was injected in the plane of the anterior saws,and the TPVB group was injected in the thoracic vertebra paravertebral injection,both of them were single injection.Anesthesia induction was performed routinely after block,and Remifentanil,Cisatracurium besilate and Propofol were used for anesthesia maintenance.Appropriate values of PETCO2 and BISwerecontrolled intraoperatively,and PCIA intravenous analgesia was used postoperatively.The anesthetic dose of the two groups were compared and analyzed during perioperative,and the visual simulation score（VAS score）of the two groups at different time points was calculated and analyzed,namely,the waking time（T1）,2h（T2）,4h（T3）,6h（T4）,12h（T5）and 24h（T6）.Length of postoperative hospital stay,duration of analgesic pump use and postoperative complications were recorded and analyzed.Statistical analysis and measurement data were expressed as mean standard deviation（S）,and t test was used for two independent samples.Counting data is expressed as a percentage.Results:1.Weight,age,operation time and length of stay of patients in the two groups were analyzed,and the differences were not statistically significant（P>0.05）.2.There were no statistically significant differences in intraoperative remifentanil,intraoperative propofol dosage and postoperative PCIA analgesic pump usage between the two groups（P>0.05）.The numbers of PCIA was significantly higher in SPB group[（2.0 1.1）]than in TPVB group[（1.1 1.0）]（P<0.05）.3.There was no significant difference in postoperative VAS score between SPB group（1.2±1.1）and TPVB group（1.5±0.7）at time T₁（P>0.05）.At T₂,VAS scores of the two groups were compared between the SPB group（1.2±0.8）and the TPVB group（1.6±0.7）,and the difference was statistically significant（P<0.05）.There was no significant difference in VAS score between the two groups at T₃ and T₄（P>0.05）.There were statistically significant differences in VAS scores at T₅ and T₆（P<0.05）.4.Postoperative nausea and vomiting occurred in 4 patients in both groups,and Ondansetron hydrochloride was immediately injected.There were 3 postoperative complications in the TPVB group（including 2 cases of hematoma at the puncture site and 1 case of pneumothorax）,and no related complications in the SPB group（P<0.05）.Conclusion:Although the duration of thoracic paravertebral nerve block is longer,its puncture is more difficult,and puncture complications are likely to occur when the ultrasound is not clear.By contrast,ultrasound-guided planar saws block is simple,superficial and easy to be seen by ultrasound,which is a good analgesic technique for thoracic surgery instead of thoracic paravertebral nerve block.