Comparison Of Quadratus Lumborum Block Versus Thoracic Paravertebral Nerve Block On Postoperative Analgesia And Immune Function In Radical Nephrectomy For Renal Cancer

Objective:To compared the effect of ultrasound-guided quadratus lumborum block（QLB）versus thoracic paravertebral nerve block（TPVB）combined with patient controlled intravenous analgesia（PCIA）with dezocine on postoperative analgesia and immune function in radical nephrectomy for renal cancer.Methods:A total of 90 patients who received laparoscopic radical nephrectomy for renal cancer were randomly divided into two groups:QLB group and TPVB group（n=45）.Ultrasound-guided QLB and PVB were respectively used in QLB and TPVB groups before induction of anesthesia.The primary outcomes were（1）postoperative analgesia during cough by recording the visual analogy score（VAS）at 0～4h,4～12h,12～24h and 24～48h after surgery,the effective number of PCIA presses,consumption of fentanyl.（2）Cellular immunity and humoral immunity on the first and third day after operation.The secondary outcomes including following contents:（1）General condition of the patient（2）Hemodynamic parameters at preoperative（T1）,after blockade（T2）,beginning of the operation（T3）,after renal resection（T4）and immediate postoperative（T5）.（3）surgical time,anesthesia time,wake up time,dosage of intraoperative analgesics,etc.（4）Incidence of adverse reaction including falls,nausea,vomiting,etc.Results:（1）General variables comparison:The age,sex,BMI and other general variables etc between these two groups were similar（P>0.05）.（2）Comparison of hemodynamic parameters:MAP,HR and Sp O₂ between these two groups at each time points were similar（P>0.05）.（3）Perioperative variables comparison:surgical time,anesthesia time,introperative analgesic dosage and recovery time etc between these two groups were similar（P>0.05）.（4）Comparison of postoperative analgesia and analgesic dosage:VAS score,effective number of PCIA compressions 0-4h postoperative cough between the two groups were not statistically significant（P>0.05）.Compared with the patients in the QLB group,the VAS score and the effective number of PCIA compressions were significantly reduced in the TPVB group during the period of 4-12h,12-24h and 24-48h postoperatively（P<0.05）.There was no statistically significant difference in fentanyl recovery amount between 0-4h,4-12h after surgery between the two groups（P>0.05）,but patients in the TPVB group had 12-24h after surgery and 24-48h after surgery,document help the amount of fentanyl recovery in the period was lower than that in the QLB group（P<0.05）.（5）Postoperative cellular and humoral immune function:CD3+,CD3+CD4+,CD3+CD8+,CD3-CD16+CD56+and CD19+level at the postoperative 1^stt day between these two groups were both similar（P>0.05）,Compared with the QLB group,the levels of CD3+CD4+and CD3+CD8+in the TPVB group on the 3rd day after surgery significantly increased（P<0.05）,but there was no significant difference in the levels of CD3-CD16+CD56+and CD19+on the 3^rdd day after surgery（P>0.05）.In the meantime,IgG,IgA,IgM at the postoperative 1^stday and 3^rdday between these two groups were both similar（P>0.05）,but the level of CRP and hs-CRP at the postoperative 1^stt day and 3^rdd day after surgery in TPVB group were both reduced in comparison with QLB group（P<0.05）.（6）comparison of the incidence of adverse:compared with the QLB group,the incidence of postoperative drowsiness,nausea and vomiting in the TPVB group was significantly reduced（P<0.05）.Conclusion:Both QLB and TPVB combined with dizocine PCIA can provide effective postoperative analgesia for patients undergoing laparoscopic radical nephritis surgery,but TPVB combined with dizocine PCIA has a better and more lasting analgesic effect,and can reduce postoperative cellular immune suppression and inflammatory response.