Clinical Observation Of Intraoperative Intercostal Nerve Block In Postoperative Analgesia After Thoracoscopic Lobectomy

Objective: To analyze the analgesic effect of intravenous patient controlled analgesia and intercostal nerve block during thoracoscopic lobectomy.Looking for appropriate thoracoscopic analgesic analgesics and analgesic drugs to speed up the recovery of patients.Methods:We had collected the patients undergoing thoracoscopic lobectomy from May2017 to November 2017.Based on strict admission and exclusion criteria.Grade I-II according to the American Society of Anesthesiologists(ASA).All subjects underwent routine preoperative examination,Exclude the patients who past thoracotomy,mental illness,alcoholism,longterm use of analgesic drugs,Liver or kidney insufficiency or serious cardiovascular disease.A total of 80 subjects included in the study,It Included 35 males and 45 females at age of 41~76(average 49.52±7.41)years old.All patients underwent excisional thoracoscopic lobectomy under duallumen intubation general anesthesia after excluding the relevant surgical contraindications.They were randomly divided into two groups:A Compound Lidocaine Hydrochloride Injection for Intercostal Nerve Block(INB)And patient controlled intravenous analgesia(PCIA).40 people in each group,received INB intraoperatively and IPCA postoperatively.Observe and record the patient within 72 h after different time periods(6h,12 h,24h,48 h,72h)visual analogue scale(VAS)and Prince Henry Pain Scale(PHPS),The operation time,postoperative analgesic side effects,gastrointestinal function recovery time,the nature of the pain,the specific site of pain and the time of removing the chest drainage tube were recorded.Results:There was no significant difference in sex,age,smoking history,history ofhypertension,history of diabetes mellitus and operation time between INB group and PCIA group(P > 0.05).There was no significant difference in the time of first fart between INB group and PCIA group after operation(P>0.05).The incidence of nausea and vomiting(4,2)in INB group was less than that in PCIA group(15,7),and the difference was statistically significant(P < 0.05).There was no significant difference between the two groups in the total time of postoperative chest drainage.The amount of dezocine added in INB group(17.12±7.50mg)was less than PCIA group(22.12±6.87mg),the difference was statistically significant(P=0.03).Postoperative pain in two groups of patients often appear around the chest drainage tube,surgical incision and chest wall,the most prone to pain around the chest drainage tube.The most common postoperative pain were followed by swelling,tingling and numbness.The analgesic effect of PCIA group(2.32 ± 1.11,3.67 ± 1.26,3.15 ± 1.07)at 6h,12 h,24h was better than INB group and had statistical significance(P=0.001?P=0.043?P=0.047).However,the analgesic effect of INB group(2.97 ± 1.02,2.30 ± 1.09)at 48 h and 72 h was better than that of PCIA group(3.87 ± 1.52,3.07 ± 1.11),with statistical significance(P=0.003 ?P=0.002).And the same results were found in the postoperative coughing PHPS assessment(P<0.05).Conclusio:PCIA analgesia after thoracoscopic lobectomy with a significant effect within 24 hours,but postoperative nausea and vomiting a-nd other adverse reacti ons,while additional dezocine more dosage.Thoracoscopy line INB long duration of analgesia when patients cough and deep breathing is good analgesic effect,l ow incidence of adverse reactions,and high patient satisfaction,help patients afte r thoracos-copic lobectomy accelerated rehabilitation.