Application Research Of Thoracic Paravertebral Nerve Block In Thoracoscopic Surgery

Ultrasound-guided single-vs double-level thoracic paravertebral block for stress reaction and hemodynamics in video-assisted thoracoscopic surgeryObjective We conducted this study to evaluate the stress reaction,hemodynamics and post-thoracic surgery pain of single-vs double-level ultrasound-guided TPVB in patients undergoing thoracoscopic lobectomy of lung.Methods Sixty patients were rando mly assigned to single-level TPVB(group S,n=20),double-level TPVB(group D,n=20)and composite group(group C,n=20).Patients received either single-(group S)or double-level(group D)ultrasound-guided TPVB at T4-5 or at T3-4 and T5-6 levels,respectively,using 20 ml of local anesthetics.Heart rate(HR)and mean arterial pressure(MAP)were recorded before anesthesia(T0),1h after one lung ventilation(T1),before resuming two lung ventilation(T2),at the end of operation(T3),1,4 and 24 h after operation(T4,T5,T6).Glucose,cortisol and 8-isoprostane were analyzed by ELISA or blood gas analysis at the time of T0,T1,T2 and T3.Results Compared with group C,there was no significant difference in HR and MAP between group S and group D at any point,the blood glucose and 8-iso concentration in group D were significantly lower at T3(P<0.05),the VAS pain scores were significantly lower in group S and group D within 48 hours after operation(P<0.05).There was no significant difference in the incidence of postoperative nausea and vomiting,dizziness,hypotension and pruritus among the three groups.Conclusion Ultrasound-guided double-level TPVB is more effective than single-level TPVB in blocking the transmission of peripheral noxious stimuli to the central nervous system during VATS,reducing the production of stressors and decreasing the degree of stress response.Comparing the analgesic efficacy of two different thoracic paravertebral block methods in lobectomy via video-assisted thoracoscopic surgeryObjective To compare the analgesic efficacy of double-level thoracic paravertebral block(TPVB)versus continuous thoracic paravertebral block in lobectomy via video-assisted thoracoscopic surgery.Methods Ninety nine patients were rando mly assigned to double-level TPVB(group G1,n=33),continuous TPVB(group G2,n=33)and composite group(group G0,n=33).The patients in group GO were given only PCIA postoperatively.The patients in group G1 were given ultrasound-guided double-level TPVB preoperatively and PCIA postoperatively.The patients in group G2 were given a 20 G thoracic catheter insertion in the paravertebral space via ultrasound guide preoperatively and continuous TPVB postoperatively.The primary outcome was the visual analog scale(VAS)at rest and coughing in 1 hour,4 hours,24 hours and 48 hours after surgery.Secondary outcomes included,emergence time,extubation time,the consumption of general anesthetics,sedation score(Ramsay),PCA demand times and adverse events at postoperatively.Results Compared with group G0,there were lower pain intensity scores at rest or on cough at each time point in group G1 and group G2(P<0.05);the incidence of emergence agitation,emergence time,extubation time,the consumption of sufentanil and sevoflurane in group G1 and group G2 were significantly less than those in group GO(P<0.05),while no differences were found between group G1 and group G2(P>0.05);The total incidence of adverse events in group G2 was less those in group GO and group G1(P<0.05).Conclusion Both preoperatively double-level TPVB combined PCIA and continuous TPVB were an effective and safe method to relieve acute pain after VATS,but the former was less adverse events as a perioperative analgesia regimen.