Comparison Of Perioperative Analgesic Effect Between Erector Spinal Plane Block And Paravertebral Nerve Block In Patients Undergoing Thoracoscopic Lung Cancer Surgery

Objective To compare the analgesic effects of ultrasound-guided erector spinae plane block（ESPB）and thoracic paravertebral block（TPVB）in patients undergoing thoracoscopic surgery for lung cancer.Method A total of 120 patients aged 25-75 who underwent thoracoscopic lung cancer surgery at a selected period were randomly divided into three groups（40patients in each group）with ASAI-II grade.The control group（group C）did not undergo nerve block;the erector spinae plane block group（group E）,preoperative 0.5%ropivacaine 20 ml at T5 and T8 levels for unilateral ESPB;thoracic paravertebral block group（group P）,preoperative 0.5%ropivacaine 20 ml at T₅ and T₈ levels for unilateral TPVB,endotracheal intubation was used during the operation and patient controlled intravenous analgesia（PCIA）was given after the operation.The changes of blood pressure and heart rate during intubation（T₁）,tracheal intubation（T₂）,skin incision（T3）,extubation（T4）and the use of remifentanil during operation were observed.Visual Analogue Score（VAS）of resting state and cough state at 1h,3h,5h,7h,24h,48h after operation as well as the complications such as postoperative nausea,vomiting,dizziness,urinary retention and extrapleural hematoma were also observed.Result There was no significant difference between the three groups in Mean Blood Pressure（MBP）and Heart Rate（HR）at T1 time（P>0.05）.At time points T2^T4,MBP and HR in group C were significantly higher than T1（P<0.05）.At time points T2^T4,MBP and HR of group E and P were significantly lower than those of group C at the same time point（P<0.05）,while the difference between group E and P was not statistically significant（P>0.05）.2.The intraoperative use of remifentanil in group E and group P was significantly lower than that in group C（all P<0.05）,while the difference between group E and group P was not statistically significant（P>0.05）.1 h,3 h,5 h after surgery,7 h,E and P group of resting and cough Visual analog pain Score（Visual Analogue Score,VAS）were significantly lower than that of group C（P<0.05）,and compare differences between group E and P way no statistical significance（P>0.05）,24 h and 48 h of three groups of patients resting and coughing pain VAS comparing differences between group has no statistical significance（P>0.05）,group E and postoperative analgesia pump automatic control on the number of P group were significantly lower than that of group C（P<0.05）,The difference between group E and group P was not statistically significant（P>0.05）.3.The incidence of nausea,vomiting and dizziness in group E and group P was lower than group C（P<0.05）.There was no statistically significant difference in the incidence of extrapleural hematoma between the two groups（P>0.05）.There was no significant difference in the incidence of urinary retention between the three groups（P>0.05）.Conclusion ESPB and TPVB are beneficial to the stability of hemodynamics during the perioperative period of thoracoscopic lung cancer surgery,and provide effective postoperative analgesia,while significantly reducing the incidence of postoperative nausea,vomiting,dizziness and other adverse reactions.However,TPVB has the risk of extrapleural hematoma,therefore,it will be safer to refer to ESPB.