Clinical Study Of The Analgesic Effect Of Thoracic Paravertebral Nerve Block After Thoracoscopic Lobectomy

Objective:To compare the analgesic effect of thoracic paravertebral nerve block(TPVB)guided by ultrasound and direct vision combined with patient-controlled-intravenous-analgesia(PCIA)after thoracoscopic lobectomy.Methods:90 patients(July,5 th to December 30th,2017)undergoing thoracoscopic(three-hole)lobectomy were randomly allocated into three groups(n=30 each):Ultrasound-guided TPVB combined with PCIA group(group U),ultrasound-guided TPVB was performed after the end of surgery,patients were received PCIA after tracheal extubation.TPVB was performed under direct vision combined with PCIA group(group D),TPVB was performed under direct vision at the end of the operation,combined with PCIA group after tracheal extubation.PCIA group(group C),patients were received PCIA after tracheal extubation.Record block operating time of group U and group D.The sensory level of block was assessed with pin-prick sensation after tracheal extubation.The visual analogue scale(VAS)score at rest and during coughing/movement at 2h,4h,6h,8h,10h,12h,24h,48h,72h after surgery,as well as vital signs(heart rate,blood pressure,respiratory rate,SPO2)were recorded.Record the total consumption of patient-controlled analgesia pump in 48h after surgery.Observe and record the incidence of postoperative agitation,nausea,vomiting,respiratory depression,and pulmonary complications.The incidence of hypotension within 2 hours after the end of TPVB in group U and group D,and the end of surgery in group C was recorded.The degree of patient’s satisfaction with analgesia was assessed.Results:The block operating time was significantly shorter in group D compared with group U(P<0.05).The average sensory level of block was 6.64±0.92 in U group and 5.50±0.50 in D group,the level in U group was wider(P<0.05).VAS score at rest and during coughing/movement was lower in group U and group D compared with group C within 72h after surgery(P<0.05),there was no significant difference between Group U and group D in the VAS score at rest and during coughing/movement wihin 72h after surgery(P>0.05).Compared with group C,the total analgesic consumption in 48h after surgery was significantly decreased in group U and group D(P<0.05).Compared with group U,the total analgesic consumption was lower in group D in 48h after surgery(P<0.05).Compared with group C,the degree of patient’s satisfaction with analgesia was increased,the incidence of agitation and pulmonary complications were lower in group U and group D(P<0.05).However,the incidence of nausea,vomiting and respiratory depression were not significant difference between the three groups(P>0.05).There was no hypotension occurred within 2 hours after the end of TPVB in group U and group D and the end of surgery in group C.Conclusion(s):1,The analgesia efficacy was equivalent of TPVB under direct vision and TPVB under ultrasound guidance in thoracoscopic lobectomy,they both provided better pain relief than only PCIA administration.2,TPVB under direct vision is easier to operate,its range of block is more definite,it should be popularized.