| Background and objectiveCancer is a major public health problem worldwide.The adoption of lifestyle behaviors that are known to increase cancer risk,such as smoking,poor diet,physical inactivity.In 2018,the United States added 1,735,350 cancers and 609,640 cancer deaths.Lung cancer is the most common malignant tumor in the world and the leading cause of cancer death.The incidence and mortality rate of lung cancer in China ranks first in t he malignant tumors.Surgery is the main treatment of solid tumors,but recurrence and metastasis after tumor surgery are the main reasons for the survival rate of patients.During the surgical treatment of cancer patients,many factors in the perioperative period affect their prognosis,such as body temperature,blood transfusion,choice of anesthetic drugs and anesthesia,and choice of surgical methods.In recent years,anesthesiologists have paid more and more attention to research directions to improve the long-term prognosis of cancers.Therefore,we conducted a prospective randomized controlled trial to investigate the effect of anesthesia on the prognosis of patients with cancer from an anesthesia perspective and a meta-analysis to evaluate the safety and efficacy of dexmedetomidine combined with local anesthetics in thoracic paravertebral nerve block.To provide the clinical basis for selecting thoracic paravertebral nerve block anesthesia for lung cancer patients.Materials and methodsRCT: 112 lung cancer patients undergoing radical resection were assigned to the PPA or SGA group.In the PPA group,thoracic paravertebral nerve block anesthetic was performed successfully with local injection of 0.5 % ropivacaine(2.0 mg/kg)before induction of anesthesia,anesthesia was maintained with the target controlled infusion(TCI)of propofol(plasma concentration of 2.6~3.2 ?g/ml)and intravenous remifentanil.In the SGA group,anesthesia was maintained with 1.0~1.5(minimum alveolar concentration,MAC)sevoflurane and intravenous remifentanil.We observed opioid consumption intraoperative and 24 h postoperative,the pain scores at 2h,8h,24 h,48h,72 h after surgery,as well as the serum concentrations of VEGF-C and TGF-?1 in 40 patients before surgery and 24 h after surgery.Meta-analysis: An electronic database search from inception date to February 2018 was performed,including PUBMED,MEDLINE,EMBASE,Web of Science,Cochrane Central Register of Controlled Trials and Cochrane Library.Randomized clinical trials(RCTs)comparing DEX as an adjuvant to LAs with LAs alone for PVB in adult patients were included.Postoperative pain scores,duration of analgesia,cumulative perioperative analgesic consumption,and adverse events were analyzed.ResultsRCT: The amount of intraoperative remifentanil consumption in the PPA group was significantly lower than in the SGA group(P<0.01),the amount of sufentanil consumption at 24 h postoperative was significantly lower than in the SGA group(P<0.01),and the VAS score at 2h,8h and 24 h postoperative was significantly lower than in the SGA group(P<0.01).At 24 h after surgery,the serum VEGF-C levels were lower in group PPA compared with the group SGA [629(203)vs 908(222)pg/ml,P=0.030],the serum TGF-?1 levels were lower in group PPA compared with the group SGA [8.37(2.84)vs 10.57(2.47)ng/ml,P=0.021].Meta-analysis: We identified 7 trials enrolling 350 patients and found that DEX reduced pain scores at rest by SMD –0.86 cm(95% CI [–1.55,–0.17],P = 0.01)and SMD –0.93 cm(95% CI [–1.41,–0.26],P = 0.008)at postoperative 12 h and 24 h,respectively.DEX reduced pain scores while dynamic by SMD –1.63 cm(95% CI [–2.92,–0.34],P = 0.01)and SMD –1.78 cm(95% CI [–2.66,–0.90],P = 0.007)for postoperative 12 h and 24 h,respectively.DEX extended the duration of analgesia by WMD 201.53 minutes(95% CI [33.45,369.61],P = 0.02);and reduced cumulative postoperative analgesic consumption by WMD –7.71 mg(95% CI [–10.64,–4.78],P < 0.001)and WMD –45.64 mg(95% CI [–69.76,–21.53],P < 0.001)for 24 h morphine and 48 h tramadol subgroups,respectively.DEX also increased the odds of hypotension by OR 4.40(95% CI [1.37,14.17],P = 0.01);however,there was no statistically significant difference for intraoperative fentanyl consumption and the incidence of the bradycardia.ConclusionsThoracic paravertebral nerve block-propofol intravenous balance general anesthesia can reduce opioids consumption for patients undergoing radical surgery for lung cancer,improve the postoperative analgesic effect,and reduce the concentration of serum tumor angiogenesis-related factors at 24 h after surgery.It is suggested that thoracic paravertebral nerve block-propofol intravenous balance general anesthesia is better than sevoflurane inhalation balanced general anesthesia for lung cancer patients undergoing radical resection.DEX combined with LAs in PVB significantly improved postoperative pain scores,prolonged the duration of analgesia,reduced postoperative analgesic consumption,and increased the odds of hypotension.However,we cannot neglect the heterogeneity of the included RCTs.More large-scale prospective studies are needed to further clarify the above conclusions. |
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