| Paravertebral nerve block(PVB)has attracted more attention to the treatment of anesthesiologists,for its simple operation and lower complication rate,which has been applied to various of pain,at the same time ultrasound visualization technology makes nerve block puncture more safety,more effictive,and complications increased significantly,especially in the field of anesthesia,this technology is used more widespread.Compared with the open chest surgery,the trauma of video-assisted thoracic lung surgery(VATS)has been greatly reduced,and short recovery period,which has widely carried out in the Department of thoracic surgery operation,but the dynamic fluctuation of blood flow and the inadequate perioperative analgesia due to pulmonary complications such as infection,postoperative effective ventilation decreased,suppression of cough reflex not effective expectoration,pulmonary atelectasis still can not be ignored,particularly in the frail elderly.The aim of this study is to investigate the effect of ultrasound-guided single point paravertebral block which uesed ropivacaine combined with methylene blue on hemodynamic fluctuations,postoperative analgesia and analgesic time in thoracoscopic lung surgery.Sixty patients scheduled for thoracoscopic lung surgery at the First Affiliated Hospital of Hebei North University,according to the random number table method were divided into three groups: Ropivacaine paravertebral nerve block group(group L),ropivacaine and methylene blue paravertebral nerve block group(group L+M)and general anesthesia group(group D),20 cases in each.The three groups of patients underwent routine anesthesia induction,patients underwent combined intravenous inhalation anesthesia for anesthesia maintenance,according to the patient’s height and weight decide to use left or right side of the double lumen endotracheal intubation,using fiberoptic bronchoscopy positioning the double lumen endotracheal intubation,and the patients were mechanically ventilated.Blocking T4,T5,T6 showed that,group L of each point were given 0.4% ropivacaine 5ml,group L+M of each block point were treated with 0.4% ropivacaine +0.05% 5ml methylene blue,group D received general anesthesia,all of them didn’t use postoperative intravenous analgesia(PCIA).Recorded cycle monitoring indicators(MAP and HR)at baseline(T1),before skin incision(T2),1 minutes after skin incision(T3),close chest(T4)and 30 minutes after extubation(T5).After the patients and the families studied the Visual analogue scale,then quiet and cough visual analogue scale(VAS)were recorded at 2 hours’,6 hours’,12 hours’,24 hours’ and 48 hours’ after operation,and record the analgesic in the total after surgery and postoperative 48 h.If the patients’ quiet VAS score more than 4 points,according to the general condition of patients with Dezocine Injection 5-10 mg.Through the collection of the different groups of patients during the perioperative period of MAP and HR,the records of all patients cough and quiet visual analogue score,48 h postoperative supplemental analgesic amount were obtained after the treatment: at T3,T4,T5,cycle parameters(MAP and HR)of group L and group L+M during operation were lower than group D(P<0.05);there was no significant difference in MAP,HR between group L and group L+M(P>0.05),VAS scores in the group L at 6h~12h were lower than those in the gtoup D(P<0.05).There was no significant difference in VAS score between 24 h and 48 h after operation in group D(P>0.05).Compared with the D group,the VAS scores at all time points in 48 h and at the time of coughing were reduced in group L+M(P<0.05).Compared with the group L,the VAS score of 24 h and 48 h in group L+M was lower(P<0.05).Group L+M compared to the other two group 48 h postoperative analgesia using reducing dosage(P<0.05).Then we came to the conclusion that compared with general anesthesia,general anesthesia combined with ultrasound-guided paravertebral nerve block can make patients’ circulation more stable in thoracoscopic lung surgery,the perioperative management is more controlled,and the pain degree of patients can be reduced in the postoperative period.It’s more conducive for patients to cough out the expectoration.In the recovery stage,ultrasound guided ropivacaine combined with methylene blue paravertebral nerve block can prolong the duration of analgesia significantly compared with the application of ropivacaine alone.Ultrasound-guided ropivacaine combined with methylene blue paravertebral nerve block reduces the total amount of postoperative analgesic drugs compared with general anesthesia,which can increase patient satisfaction and facilitate postoperative rapid rehabilitation. |
