Correlation Study Of Ropivacaine With Local Anesthetic Adjuvant In A Peripheral Nerve Block For Thoracoscopic Lobectomy Perioperative Analgesia

Objective:To investigate the clinical value of ropivacaine with local anesthetic adjuvant in peripheral nerve block for thoracoscopic lobectomy analgesia.Methods:A total of 120 patients with elective thoracoscopic lobectomy under general anesthesia were selected,male or female,aged 30-70 years,body mass index(BMI)18-30kg/m~2,and American Society of Anesthesiologists(ASA)grade I-II.Randomly divided into four groups:ropivacaine group(R group),ropivacaine+dexmedetomidine group(R1 group),ropivacaine+dexamethasone group(R2 group)and ropivacaine+butorphanol group(R3 group).All patients were induced with the same method of routine intravenous rapid anesthesia,after intubation of double-lumen endotracheal tube under visual laryngoscope,the affected side was taken to lie on the upper side,and the thoracic paravertebral nerve block,combined with erector spinae plane block was performed under ultrasound guidance.R group:0.5%ropivacaine 30ml+normal saline 5ml mixed solution,a total of 35ml;R1 group:0.5%ropivacaine30ml+1μg/kg dexmedetomidine mixed solution,a total of 35ml;R2 group:0.5%ropivacaine 30ml+8mg dexamethasone mixed solution,a total of 35ml;R3 group:0.5%ropivacaine 30ml+2mg butorphanol mixed solution,a total of 35ml.Observation index:perioperative propofol and sufentanil consumption,anesthesia awakening and extubation time,the time of postoperative first request for remedial analgesia and postoperative NRS scores at 1h,6h,12h,24h and 48h,total sufentanil consumption in the analgesic pump at 48h postoperatively,postoperative flurbiprofen axetil remedial analgesic dose and incidence of adverse effects such as hypotension,bradycardia,respiratory depression,pulmonary infection,nausea and vomiting and neurotoxicity at 48h postoperatively.Results:Intraoperative sufentanil consumption,anesthesia awakening and extubation time of patients were lower in groups R1,R2 and R3 than in group R(P<0.05),intraoperative sufentanil consumption of patients was lower in group R1 than in group R3(P<0.05),and anesthesia awakening and extubation time of patients was lower in group R2 than in group R3(P<0.05).The time to first postoperative remedial analgesia of patients was prolonged in groups R1,R2,and R3 compared with group R(P<0.05),the time to first postoperative remedial analgesia of patients was prolonged in patients in groups R1 and R2 compared with group R3(P<0.05).Postoperative sufentanil consumption and flurbiprofen axetil remedial dose of patients were lower in groups R1,R2,and R3 than in group R(P<0.05),and postoperative sufentanil consumption and flurbiprofen axetil remedial dose of patients were lower in R1 and R2 groups than in R3 group(P<0.05).The postoperative NRS scores at 1h,6h,12h and 24h of patients were lower in R1 and R2 groups than in R group(P<0.05),the postoperative NRS scores at 1h,6h and 24h of patients were lower in R1 group than in R3 group(P<0.05),There was no significant difference in 48h NRS scores among the four groups(P>0.05).Conclusion:Ropivacaine with dexmedetomidine,dexamethasone or butorphanol in TPVB with ESPB in patients undergoing thoracoscopic lobectomy could prolong the time to first postoperative remedial analgesia,reduce perioperative sufentanil and postoperative remedial analgesic drug dosage,and decrease postoperative NRS scores,but dexmedetomidine or dexamethasone as ropivacaine adjuvant has better analgesic duration and intensity than butorphanol.