Effect Of Butorphinol Combined With Ropivacaine In Ultraound-Gudied Thoracic Paravertebtal Block On Stress Response And Postoperative Analgesia In Patients Undergoing Thoracoscopic Radical Resection Of Lung Cancer

Objective:To investigate the effect of butorphanol combined with ropivacaine in ultrasound-guided thoracic paravertebral block（TPVB）on stress response and postoperative analgesia in patients undergoing thoracoscopic radical resection of lung cancer.Methods:90 patients scheduled for thoracoscopic radical resection of lung cancer were randomly divided into three groups with 30 cases each,black control group（group C）,ropivacaine paravertebral nerve block group（group T）,butorphanol combined with ropivacaine paravertebral nerve block group（group TB）.Group T and group TB received TPVB 15minutes before the surgery begin,patients were received 0.375%ropivacaine 20 ml（group T）or butorphanol 1mg combined with 0.375%ropivacaine 20ml（group TB）,while the patients in group C were given the general anesthesia.Both three groups recieved postoperative patient controlled intravenous analgesia（PCIA）.The HR and MAP at the time of admission to the operating room（T₁）,at 1 min before surgical skin incision（T₂）,at 5 min after surgical skin incision（T₃）,at the end of the surgery（T₄）and at 5 min after anesthesia extubation（T₅）were recorded.Venous blood samples were detected for measurement of the plasma concentration of noradrenaline（NE）at the time of T₁,T₃,T₅.The dosage of propofol,remifentanil,postoperative extubation time,and postoperative remedial analgesic drug during time of 24h after the surgery were also recorded.The resting and cough state VAS scores at 4h,8h,12h,24h,48h after operation were recorded too.Results:（1）Compared with T₁,the MAP and HR were decreased at T₂in three groups（P<0.05）;Compared with T₂,the MAP and HR were raised at T₃in three groups（P<0.05）;Compared with group C,the MAP and HR were decreased at T₃,T₄,T₅in group T and group TB（P<0.05）,no significant change was found in MAP and HR at any time point in group T and group TB（P>0.05）.（2）Compared with T₁,the plasma concentration of NE were raised at T₃and T₅in group C（P<0.05）;Compared with group C,the plasma concentration of NE was lower at T₃,T₅in group T and group TB（P<0.05）,there was no significant change found in the plasma concentration of NE at T₁,T₃,T₅in group T and group TB（P>0.05）.（3）There was no significant difference in the dosage of propofol in the three groups（P>0.05）;compared with group C,the dosage of remifentanil in group T and group TB was significantly decreased（P<0.05）;the extubation time of group T and group TB were shorter than group C（P<0.05）;the use of postoperative remedial analgesic drugs during 24 hours after the surgery in group C and group T was higher than group TB（P<0.05）.（4）Compared with group C,whatever at rest or in cough,group T had lower VAS scores at4h,8h after surgery（P<0.05）,group TB had lower VAS scores at 4h,8h,12h,24h,48h after surgery（P<0.05）,group TB had lower VAS scores at12h,24h,48h after operation than group T（P<0.05）.Conclusion:Ultrasound-guided TPVB for thoracoscopic radical resection of lung cancer can maintain intraoperative hemodynamic stability,reduce the dosage of opioids,reduce stress response and relieve postoperative pain;butorphanol as an adjuvant can prolong the analgesic time of ropivacaine and optimize the analgesic effect,it can be safely used in clinic and produces better efficacy.