The Effect Of Thoracic Paravertebral Nerve Block Combined With Serratus Anterior Plane Block In VATS Lobectomy

Objective:To compare thoracic paravertebral block（TPVB）with serratus anterior plane block（TPVB）.SAPB)in patients with lobectomy in Video-assisted Thoracoscopic Surgery（VATS）,in terms of intraoperative stress,postoperative analgesia and adverse reactions.Methods:Sixty patients undergoing thoracoscopic lobectomy were randomly divided into general anesthesia combined with TPVB group（group T,n=20）,general anesthesia combined with SAPB group（group S,n=20）and general anesthesia combined with TPVB and SAPB group（group C,n=20）.All three groups were treated with nerve block combined with general anesthesia.The study was approved by the ethics committee,and informed consent was obtained from the patients.After entering the operating room,the patients were monitored,and 0.33%ropivacaine was used for nerve block in the three groups.Before the nerve block operation,the patients were given analgesia and sedation.Patients in group T and group C were treated with thoracic paravertebral nerve block,20ml of medication;Patients in group S and group C were given serratus anterior plane block with 20ml of medication.After the above operations were completed,general anesthesia was induced in the three groups.When the muscle relaxation reached a certain depth,double-lumen bronchial intubation was used and the positioning operation was performed by fiberoptic bronchoscopy.Patient controlled intravenous analgesia（PCIA）pump with the same ratio was used after operation.Mean arterial pressure（MAP）and Heart rate（HR）were recorded before anesthesia induction（T0）,before skin incision（T1）,5min after skin incision（T2）,before the end of surgery（T3）and 2h after surgery（T4）.Pao2 was recorded before and 24 hours after operation.The duration of operation and intraoperative dose of remifentanil were recorded.The extubation time of patients in the ward ICU was recorded.The VAS scores in resting state and cough state were recorded at 15min,4h,8h,12h and 24h after extubation.The occurrence of nausea and vomiting within 24h after operation was recorded.The occurrence of block-related complications such as hematoma,pneumothorax and infection at the puncture site was recorded.Results:1.There was no significant difference in gender,age,height,weight and operation time among the three groups（P>0.05）.2.The consumption of remifentanil in group T（0.91±0.34）and group C（0.83±0.25）was less than that in group S（1.26±0.53）,and the difference was statistically significant（P<0.05）.3.There was no significant difference in MAP and HR among the three groups before anesthesia induction（P>0.05）.MAP and HR decreased significantly at T1,but there was no significant difference among the three groups（P>0.05）.At T2,the changes of MAP and HR in group T and group C were more stable（P<0.05）.At T3,MAP and HR in group S were higher than those in group T and group C（P<0.05）.At T4,MAP and HR in group C were at a lower level（P<0.05）.4.There was no significant difference in VAS score at rest between groups and at each time point（P>0.05）.5.When coughing 15min after extubation,4h and 8h after operation,the VAS scores of group C were lower than those of group T and group S,and the VAS scores of group S were lower than those of group T,the differences were statistically significant（P<0.05）.6.The Pa O₂of the three groups decreased compared with that before operation,and compared with group C,group S and group T decreased more,and the difference was statistically significant（P<0.05）.7.There were no block-related complications such as hematoma at the puncture site and pneumothorax in the three groups,and there was no statistically significant difference in the incidence of postoperative nausea and vomiting among the three groups（P>0.05）.There was no significant difference in extubation time between groups（P>0.05）.Conclusions:In VATS lobectomy,TPVB can mainly reduce the intraoperative stress response,while SAPB can mainly reduce the pain caused by drainage tube stimulation of pleura.TPVB combined with SAPB has a clear analgesic effect in thoracoscopic surgery.It is better than simple paravertebral nerve block or simple serratus anterior plane block in reducing intraoperative medication,alleviating postoperative pain and accelerating postoperative recovery,which is worthy of clinical promotion.