Clinical Comparison Of Ultrasound-guided Single-dose Thoracic Paravertebral Nerve Block And Epidural Block For Analgesia After Thoracoscopic Pulmonary Lobectomy

Objective: The study aims to explore a more safe and effective analgesic mode by comparing thoracic paravertebral nerve block with PCIA and epidural analgesia.Methods:Eighty patients who are taking selective thoracoscopic lobectomy in the First Affiliated Hospital of China Medical University were randomly divided into single-dose thoracic paravertebral nerve block(PSTPVB)group and epidural block(TEB)group equally.After routine monitoring,patients are injected with single-point thoracic paravertebral nerve block or epidural puncture catheter.After operation,patients in PSTPVB group were given patient-controlled intravenous analgesia(PCIA),and patients in TEB group were given patient-controlled epidural analgesia(PCEA).The primary outcomes are the number rating scale(NRS)in resting and cough state at 6?12?24?36?48 and 72 hours after operation?the incidence and degree of pain in 1 month and 2months after discharge.The second outcomes are mean arterial pressure(MAP)?heart rate(HR)and depth of anesthesia(BIS)before regional block(T1)?after regional block(T2)? before anesthesia induction(T3)?before tracheal intubation(T4)?operation start time(T5)and 3 minutes after operation(T6).Postoperative adverse reactions such as nausea and vomiting?respiratory depression?skin itching?hypotension and the operation time of regional block and the dosage of propofol ? sufentanil and vasoactive drug deoxyepinephrine during operation in the two groups are also recorded.Results: The NRS at rest and cough within 72 hours after operation in PSTPVB group was higher than that in TEB group(P<0.001).The NRS at rest within 36 hours and cough within 48 hours after operation in PSTPVB group was moderate(NRS>3),while the NRS at cough 12 hours after operation and at rest within 72 hours after operationin TEB group was mild(NRS<4).Chronic pain at 1 and 2 months after operation in both groups was mild(NRS<4).The change of MAP(4.07mmHg)before and after regional block in PSTPVB group was smaller than that(0.62mmHg)in TEB group(P=0.013),but HR(1.96bpm)before and after operation in TEB group was smaller,which was significantly different from that(6.33bpm)in PSTPVB group(P=0.003).There was no significant difference in adverse reactions such as nausea and vomiting,respiratory depression,skin itching and hypotension between the two groups(P>0.05).Theoperation time of thoracic paravertebral nerve block in PSTPVB group(5.30minutes)was shorter than that(8.71minutes)in TEB group(P<0.001).There was no significant difference in operation time,?anesthesia time?propofol and sufentanil dosage between the two groups(P>0.05).The dosage of deoxyepinephrine(0.32mg)in PSTPVB group was less than that(0.61mg)in TEB group(P=0.001).Conclusion: Generally speaking,PSTPVB has less analgesic effect than TEB on acute pain after thoracic surgery,The degree of pain can be mild to moderate pain,and the prevention effect of PSTPVB on chronic pain after thoracic surgery is similar to that of TEB.PSTPVB is more stable and time-consuming,so it can be used as an alternative method of postoperative analgesia for thoracic surgery.