Contrastive Analysis Of Different Nerve Block Guided By Ultrasonography During Perioperative Period Of Thoracoscopic Lobectomy

Objective:The purpose of this study was to investigate the intraoperative benefits and risks of ultrasound-guided thoracic paravertebral block,erector spinal plane block,and serratus anterior plane block combined with intravenous anesthesia in patients undergoing thoracoscopic lobectomy.The analgesic effects of the three groups,intercostal nerve block combined with intravenous analgesia and intravenous analgesia alone after thoracoscopic lobectomy were compared and the effects on postoperative rehabilitation were compared.Method:A total of 100 patients who were diagnosed with pulmonary nodules and underwent thoracoscopic lobectomy under general anesthesia from August 2019 to December 2020 were selected.According to the random number table,they were divided into five groups:paravertebral block(group T),erector block(group E),serratus anterior block(group S),intercostal nerve block(group C)and control group(group V),with 20 cases in each group.Except for the intercostal nerve group and the control group,nerve block in each block group was guided by ultrasound before anesthesia induction and the block effect was guaranteed.The general situation,transfusion volume,intraoperative usage of propofol and remifentanil,extubation time were recorded.Adverse reactions and VAS scores at 6h,12h,24h and 48h after surgery were recorded.First PCIA time,functional exercise time,first time of getting out of bed,postoperative eating time and postoperative hospital stay of each group were recorded.Result:1)Compared with group V and C,the dosages of remifentanil and propofol in group T,group E and group S were reduced,and the extubation time was shortened(P<0.05);2)Compared with group V,VAS scores of all groups were decreased at 6 hours of calmness or cough,VAS scores of group T and group E were decreased at 12 hours of calmness or cough,and VAS scores of groups S and C were decreased at 12 hours of calmness.Compared with group C,the cough VAS scores of group T and group E at 6 and 12 hours were decreased.Compared with T group,VAS scores at 12 hours of calm or cough were increased in group S(P<0.05);Other time points had no statistical significance among all groups;There was no significant difference in the length of postoperative hospital stay among all groups(P>0.05);The first postoperative PCIA pumping time of Group T,Group E,Group S,Group C and Group V was gradually shortened(P<0.05)compared with group V,group T,group E,group S and group C,postoperative eating,functional exercise and the first time of getting up from bed were shortened;Compared with group T and group E,postoperative eating,functional exercise and the first time of getting out of bed in group S and group C were prolonged.The first time of getting out of bed in group C was longer than that in group S(P<0.05);4)Compared with group V,postoperative nausea and vomiting rate in each group was significantly lower(P<0.05).Conclusion:The use of ultrasound for thoracic paravertebral block,erector spinal block and serratus anterior block is safe and feasible.All three can reduce the use of general anesthesia for thoracoscopic lobectomy and shorten the postoperative extubation time.Each block combined with PCIA has a certain postoperative analgesic effect,and can speed up postoperative recovery,reduce postoperative nausea and vomiting rate.Among them,thoracic paravertebral block and erectoris spine plane block combined with PCIA had the best postoperative analgesic effect,serratus anterior plane block combined with PCIA was the second,while postoperative intercostal block had a short postoperative analgesic time and limited analgesic intensity.