| Objective To evaluate the effects of thoracic paravertebral block(TPVB)and erector spinae plane block(ESPB)on stress response and postoperative analgesia in patients undergoing video-assisted thoracic surgery.Methods Ninety patients of both sexes,aged 18-64 years,with body mass index of18.5-23.9,American society of anesthesiologists physical statusⅠorⅡ,undergoing elective video-assisted thoracic surgery from October 2021 to February 2022,were randomly divided into three groups(n=30): control group(Group C),ESPB(Group E)and TPVB group(Group E).Before anesthesia induction,Ultrasound-guided TPVB and ESPB were performed with 0.5% ropivacaine 20 m L in P and T group.Total intravenous anesthesia was performed during the entire surgery.Patient-controlled intravenous analgesia(PCIA)with sufentanil 2μg/kg and metoclopramide 20 mg in 100 m L of normal saline was applied postoperatively.Venous blood samples were collected immediately before surgery(T0),30 min after the start of operation(T1),tracheal extubation(T2)for determination of blood Glucose and cortisol.The postoperative VAS score was evaluated at T2(after tracheal tube extracted),T3(12 hours after the surgery),T4(24 hours after the surgery),T5(48 hours after the surgery).The intraoperative consumption of remifentanil and the number of vasoconstrictors needed for intraoperative hypotension were recorded;The number of PCIA compressions and total infusion volume in 48 h,the use of rescue analgesia,and the occurrence of postoperative sleepiness,dizziness,nausea and vomiting were recorded during the follow up.Results1.Demographic characteristicsThere were no significant differences in general information(including age,gender ratio,BMI,duration and the type of the surgery)between the three groups of patients.2.The concentration of stress hormonesThere were no significant differences in the concentration of Cor at T0,T1 and T2 among the three groups;GLU in group T was significantly lower than that in group C at T1(P<0.05).There was no significant difference in the concentration of Cor and GLU between group T and group E at T1 and T2(P>0.05);The concentrations of Cor and GLU at T1 and T2 in Group C and E were higher than those at T0,while the concentrations of Cor and GLU at T2 in Group T were higher than those at T0(P<0.05).3.The postoperative VAS scoresThe VAS scores at rest and coughing at T2 and T4 in group T and E were significantly lower than those in group C(P<0.05).Compared with group T,VAS score at rest and coughing 12 h after operation in group E increased(P<0.05).4.Intraoperative drug dosage and postoperative observation indexes Compared with group C,the intraoperative consumption of remifentanil and the number of rescue analgesia in group T and group E were decreased,the number of vasoconstrictors used in group T and group E during the operation was increased(P <0.05);Among the three groups,the amount of remifentanil used during the operation,the total amount of sufentanil infusion,the number of effective compressions within 48 hours after the operation and the rate of relief analgesia was the lowest in group T.However,the incidence of hypotension was the highest in group T(P<0.05).There was no significant difference in the incidence of postoperative nausea and vomiting among the three groups(P > 0.05).There were no complications related to nerve block in group T and E,and no postoperative dizziness,skin itching or respiratory depression in the patients of the three groups.Conclusion1.TPVB can inhibit the stress response of patients undergoing video-assisted thoracic surgery.TPVB could provide better postoperative analgesia than ESPB,while it has a significant inhibitory effect on intraoperative blood pressure.2.Compared with total intravenous anesthesia,total intravenous anesthesia combined with nerve block can significantly reduce the consumption of opiates and relieve the pain of patients,which may be beneficial to the rapid recovery of patients after surgery. |
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