Clinical Study Of Ropivacaine Combined With Dexmedetomidine For Ultraoundguided Paravertebtal Block On Hemodynamics And Analgesia In Patients Undergoing Thoracoscopic Radical Resection Of Lung Cancer

Objective:Paravertebral nerve block（PVB）is gradually used by more and more anesthesiologists because of analgesic effect is similar to epidural block,simple operation and low incidence of complications.Ultrasound-guided nerve block can reduce the occurrence of complications,and the blocking effect is more definite.Thoracoscopic surgery is widely used in the treatment of thoracic diseases on account of its many advantages.It has the advantages of less trauma,less postoperative pain and faster recovery than traditional thoracotomy,but the patients still dare not breathe and cough due to pain 3 days after operation,and the postoperative complications have not been reduced too.Methods:96 ASAⅠ-Ⅱand aged among 47-68 years old patients scheduled for video-assisted thoracoscopic surgery were randomly divided into three groups.Patients in group C were treated with general anesthesia;patients in group T and TD were treated with paraspinal nerve block after induction of general anesthesia.Patients in group T received the TPVB with 20 ml of 0.375%ropivacaine,while received the TPVB with 20ml of0.375%ropivacaine containing 0.75μg/kg dexmedetomidine in group TD after induction.All patients in the three groups were routinely induced anesthesia,which was maintained by total intravenous anesthesia during the operation,and the intravenous analgesia devices were used after operation.The hemodynamic parameters of patients at baseline（T₁）,before skin incision（T₂）,1 minute after skin incision（T₃）,at chest closure（T₄）,at the end of the operation（T₅）and half an hour after extubation（T₆）were recorded.If the emergence agitation score is more than 2 after half an hour of awakening,gave an analgesic drug to the patients.Patients and their families were taught to identify the pain score scale.NRS scores were recorded at 1 h,4 h,8 h,12 h and 24 h after extubation,the use of rescue analgesics and adverse reactions within 24 hours after extubation were recorded.Results:at T₃、T₄、T₅and T₆,the hemodynamic indexes（HR and MAP）in group T and group TD were lower than those in group C（P<0.05）;There was no significant difference in hemodynamic indexes between group T and group TD（P>0.05）.Compared with group C,the score of emergence agitation in group T and TD was lower than that in group C（P<0.05）.Compared with group C,the NRS scores of patients in group T at4 h and 8 h after operation were lower in quiet and on cough（P<0.05）.The NRS scores in quiet and on cough at time 4 to 24 hours after operation in group TD were lower than those in group C,and the NRS scores in quiet and on cough at 12 and 24 hours after operation in group TD were lower than those in group T（P<0.05）.The dosage of postoperative rescue analgesics in group TD were lower than those in group C and group T（P<0.05）;The incidence of nausea in group T and TD was lower than that in group C（P<0.05）.There was no significant difference in the incidence of other adverse reactions among the three groups（P>0.05）..Conclusion:General anesthesia combined with paravertebral nerve block compared with general anesthesia,the intraoperative hemodynamics of patients was more stable,and the incidence of emergence agitation decreased during the recovery period.;dexmedetomidine combined with ropivacaine compared with ropivacaine for paravertebral nerve block has a longer postoperative analgesia time and can reduce the dosage of remedial analgesics,improve patients’postoperative satisfaction and accelerate their recovery.