Analgesic Effect Of Transcutaneous Electrical Acupoint Stimulation And Paravertebral Nerve Block In Thoracoscopic Lobectomy

Background:Due to small incision,less bleeding,convenient operation,and fast recovery,thoracoscopic surgery is more and more widely used in the clinic.However,at present,the pain after thoracoscopic surgery is the main reason affecting the recovery of patients.Postoperative severe pain may lead to atelectasis,pulmonary infection and affect the recovery process of patients.The thoracic paravertebral nerve block is one of the primary analgesic schemes after thoracic surgery,with a definite curative effect,but the thoracic paravertebral block can have the risk of pneumothorax,hematoma,and so on;Transcutaneous acupoint electrical stimulation is a postoperative analgesia scheme combining traditional Chinese medicine and Western medicine.It has simple operation and low risk.In recent years,it has been gradually applied to thoracoscopic postoperative analgesia.Purpose:To explore the effect of a thoracic paravertebral nerve block(Thoracic Paravertebral Blockade,TPVB)and percutaneous acupoint electrical stimulation(Transcutaneous Electrical Acupoint Stimulation,TEAS)on postoperative analgesia after thoracoscopic lobectomy.Methods:One hundred twenty-six patients who underwent thoracoscopic lobectomy were randomly divided into three groups,with 42 cases in each group.TEAS group was given electroacupuncture to stimulate acupoints 30 minutes before general anesthesia,the TPVB group was given paravertebral nerve block before general anesthesia,and the control group was used as control.General anesthesia method:the three groups of patients using the same general anesthesia method.After entering the room,the peripheral venous channel was opened,and the mean arterial pressure(MAP),heart rate(HR),oxygen saturation(SpO2),bispectral index(BIS),and end expiratory carbon dioxide partial pressure(PETCO2)were routinely monitored.Radial artery puncture and central venous puncture were performed.Induction anesthesia was given oxygen inhalation with a mask,and midazolam,rocuronium,sufentanil,and penehyclidine were successively injected intravenously.After the patient’s consciousness disappeared,a double-lumen bronchial catheter was inserted orally with the help of a fiberoptic bronchoscope to connect the anesthetic.Propofol and remifentanil were continuously injected intravenously to maintain anesthesia during the operation.The drug was stopped at the end of the operation,and the prepared PCIA was immediately connected.Visual analogue scale/score(VAS),patient-controlled intravenous analgesia(PCIA),the incidence of adverse events such as nausea and vomiting within 48 hours after the operation,and postoperative complications were recorded.Results:There was no significant difference in age,sex ratio,body mass index,ASA grade,and operation among the three groups(P>0.05).The scores of rest and exercise pain in the control group were significantly higher than those in the TEAS group and TPVB group within 48h after surgery,with statistically significant differences(P<0.05).In the TPVB group,the resting and exercise pain scores were significantly lower than those of the TEAS group within 12h after surgery,the difference was statistically significant(P<0.05),and there was no significant difference in the resting and exercise pain degree between the two groups after 24h,which was not statistically significant(P>0.05).The effective pressing times and drug dosage of PCIA in 48h after operation in the control group were significantly higher than those in the TEAS group and TPVB group.The differences were statistically significant(P<0.05).Moreover,the effective pressing times of PCIA and drug dosage in the TPVB group were significantly lower than those in the TEAS group within 48h after surgery,with statistical significance(P<0.05).The incidence of nausea and vomiting 48h after surgery in the TEAS group was significantly lowerthan that in the control group and TPVB group,with a statistically significant difference(P<0.05).However,there was no significant difference in agitation,skin itching,and vertigo among the three groups(P>0.05).There was no significant difference in the incidence of complications 48 hours after operation among the three groups(P>0.05),indicating that TEAS and TPVB are safe and reliable.Conclusions:(1)TPVB and TEAS combined with PCIA can effectively control the pain degree of patients after thoracoscopic lobectomy and reduce the application of POSTOPERATIVE PCIA analgesics,and TPVB has a more obvious analgesic effect within 12 hours after surgery.(2)TEAS can effectively reduce nausea and vomiting after anesthesia than TPVB;both methods are safe and reliable.