Observation Of Opioid-free Anesthesia And Post-operative Analgesia In Perioperative Period Of Video-assisted Thoracoscopic Surgery(VATS) In Lung Cancer

Objective:Video-assisted thoracoscopic（VATS）lobectomy surgery has made rapid progress in clinical practice due to its advantages of small trauma,light pain,quick recovery and shorten hospitalization time.The demand for anesthesia and analgesia of VATS has decreased.Opioids are the classical analgesics in the perioperative period,but the adverse reactions such as nausea,vomiting,hyperalgesia,the risk of respiratory depression and potential dependence will directly affect the rehabilitation of patients.In this study,opioid-free general anesthesia combined with thoracic paravertebral nerve block for VATS was used to studied to reduce the adverse events of opioid.Methods:This study randomly selected 120 patients who were admitted to Thoracic Surgery Department our hospital from June to December 2018 and were scheduled to undergo VATS under general anesthesia.They were divided into two groups according to the random number table method:the non-opioid anesthesia group（OFA group）and the conventional opioid anesthesia group（OA group）with 60 cases each.Peripheral veins were routinely opened after admission,and ECG,SPO₂,ABP,CVP and depth of anesthesia were monitored.In the OFA group,dexmedetomidine（Dex,1ug/kg 10min,iv,and atropine 0.5mg iv）was pumped and continuously infused at the rate of0.5ug/kg/h.After 15 minutes,4%lidocaine was used to anaesthetize the internal surface of laryngeal anesthesia tube and trachea.30 mg ketorolac tromethamine was given intravenously.Etomidate 0.2-0.3 mg/kg and cis-atracurium 0.2 mg/kg were given in turn for induction of anesthesia.In OA group,anesthesia induction was performed with sufentanil 0.2-0.4 ug/kg,etomidate 0.2-0.3 mg/kg and cis-atracurium 0.2 mg/kg.All of patients in both groups were inserted tracheal intubation and bronchia blocker.Then the thoracic paravertebral nerve block（TPVB,0.5%ropivacaine 15 ml）was performed under the guidance of ultrasound.:In the OFA group,sevoflurane inhalation,Dex（0.5ug/kg/h）continuous infusion,cisatracurium 0.05mg/kg intermittent supplementation for anesthesia maintenance.In the OA group,sevoflurane inhalation,remifentanil continuous infusion,cisatracurium0.05mg/kg intermittent supplementation.Patient control analgesia（PCA）was connected 45 minutes before the end of operation in two groups（OFA group:dexmedetomidine 6 ug/kg+ketorolactic tromethamine 180 mg;OA group:dizosin 10 mg/kg+ketorolactic tromethamine 180 mg）,and antiemetic drugs were given 15-30 minutes before the end of operation The heart rate（HR）,mean artery pressure（MAP）,pulse oxygen saturation（SPO?）,anesthesia depth depth of sedation,（cerebral wavelet index,WLI）,pain index（PI）,analgesia index（PTI）were mornitored at T1（baseline value of entry）,T2（impulse dose after 1ug/kg Dex infusion）,T3（after intubation）,T4:（chest-opening）,T5（30min after single lung ventilation）,T6（after recovery of bilateral pulmonary ventilation）,T7（after extubation）.Partial pressure of oxygen（PO?）,blood glucose（BG）,lactic acid（Lac）from blood gas were dedected at four time points（T0:basic value,T1:1h after operation beginning,T2:2h after operation beginning,,T3:extubation）.The recovery time and extubation time were recorded respectively.The VAS score,PI,PCA pressing time and rescue analgesic were recorded after operation.The occurrence of nausea and vomiting,hypoxemia and pulmonary complications were recorded.The first time of exhaust and landing after operation and the days of hospitalization after operation were recorded.Results:1.There was no significant difference in age,sex,body mass index,types and methods of operation between the two groups.2.HR was higher in OFA group than in OA group at T4（P=0.0001）,HR was lower in OFA group than in OA group at T7（P=0.0001）.MAP was higher in OFA group at T3 and T4 than in OA group（P<0.05）,and sharply decreased at T7（P=0.0002）.SPO₂ at T2 in OFA group was lower than that in OA group,the difference was statistically significant（P=0.0001）.3.PO₂ at T2 in OFA group was higher than that in OA group,the difference was statistically significant;BG at T1 and T2 in OFA group was higher than that in OA group,the difference was statistically significant（P<0.05）.There was no significant difference in lac value between the two groups at four time points（P>0.05）.4.Monitoring of anesthesia depth:There was no significant difference in PTI and PI between the two groups at each time point during operation（P>0.05）.WLI in OFA group was lower than that in OA group at T3,T4,T5 and T6time points（P<0.05）.The anxiety index of patients in OFA group was lower than that in OA group on the fourth day after operation（P=0.001）.5.There was no significant difference in anesthesia duration,operation duration,intraoperative urine volume,end-expiratory sevoflurane concentration and vasoactive drugs（ephedrine,norepinephrine）between the two groups（P>0.05）.The recovery time and extubation time of patients in OFA group were longer than those in OA group（P<0.05）.6.Postoperative exhaust time in OFA group was shorten than that in OA group,and the accurrence of nausea and vomiting in OFA group was significantly lower than that in OA group（P<0.05）.There was no significant difference in the time of drainage tube extraction and discharge（P>0.05）.7.There was no significant difference in VAS score and PI between the two groups（P>0.05）.There was no significant difference in rescue analgesics between the two groups（P>0.05）.Conclusion:Opioid-free anesthesia is safe and feasible for intraoperative management and postoperative analgesia in VATS,and has certain advantages in reducing PONV and improving patient compliance.