Effect Of Thoracic Paravertebral Nerve Block Combined With Erector Spinal Plane Block On Postoperative Analgesia After Two-hole Thoracoscopic Surgery

Objective:The effect of preoperative ultrasond-guided thoracic paravertebral nerve block（TPVB）combined with erector spinae plane block（ESPB）on postoperative analgesia after double-pore thoracoscopic surgery.Methods:Ninety patients with double-port thoracoscopic lobectomy were selected and randomly divided into control group C（28 cases）,thoracic paravertebral nerve block group T（28 cases）and thoracic paravertebral nerve block combined with erector ridge plane block group T+E（30 cases）by using the method of number table.Patients in T group and T+E group completed nerve block in the pre-anesthesia room,and the anesthesia induction and maintenance plan of the three groups were the same.Hemodynamic parameters were recorded before anesthesia induction（T₀）and during surgical resection（T₁）.Serum IL-6 and Apelin-13 levels were measured after entry（T₂）,immediately after lobectomy（T₃）,and after surgery（T₄）.Pain scores at rest and cough were recorded at 6,12,24,and 48 hours after surgery.Sleep quality scores were recorded 1 day before surgery,1 day after surgery and 2 days after surgery.The dosage of sufentanil and the number of analgesic relief cases within 48 hours after operation were recorded.The incidence of postoperative adverse reactions such as nausea,vomiting and urinary retention were recorded.Results:There was no statistical significance in the comparison of general data among the three groups（P>0.05）,which was comparable.Compared with group C,the hemodynamic fluctuation between T0 and T1 in groups T and T+E was smaller（P<0.05）.Compared with groups C and T,the increase of serum interleukin-6（IL-6）and decrease of Apelin-13 at time points T₃and T₄in group T+E were significantly lower,the pain scores at rest and cough at 6,12,24 and48 hours after surgery were lower,the sleep quality at 1 and 2 days after surgery was better,and the dosage of sufentanil at 48 hours after surgery was less.The incidence of postoperative analgesia,nausea and vomiting was lower,with statistical significance（P<0.05）.Conclusion:Ultrasound guided TPVB combined with ESPB can provide better analgesic effect,longer analgesic duration,reduced perioperative inflammatory response,reduced postoperative sleep quality,and reduced postoperative sufentanil dosage and opioid-related adverse reactions in patients with dual-port thoracoscopic.