The Effect Of Preoperative Thoracic Paravertebral Nerve Block On Early Postoperative Rehabilitation In Frail Elderly Patients Undergoing Lobectomy

Objective: To investigate the effect of thoracic paravertebral nerve block combined with general anesthesia on postoperative rehabilitation in frail elderly patients undergoing thoracoscopic lobectomy.Methods: We selected 62 frail elderly patients,29 males and 33 females,aged ≥ 60 years,who underwent video-assisted thoracic lobectomy under elective general anesthesia in the Department of Thoracic Surgery of Gansu Provincial Hospital.We considered patients whose American Society of Anaesthesiologists(ASA)classification was Ⅱ to Ⅲ and whose FRAIL scale score was ≥ 3.Patients were randomly assigned to a Combined group(Group C)and a General anesthesia group(Group G).Before anesthesia induction,an ultrasound-guided thoracic paravertebral nerve block with 20 ml of 0.5% ropivacaine was done at the relevant interval on the operative side,then followed by general anesthesia in Group C.In Group G,only general anesthesia was performed.Patients’ baseline information,quality of recovery score on 15 items(Qo R-15)after surgery at 24 hours,landing time,spontaneous breathing recovery time,length of stay in the Postanesthesia care unit,Drainage duration,and length of stay in the hospital were recorded.Patient’s postoperative visual analogue of pain(VAS)scores at 2 hours,24 hours,and 48 hours,the consumption of sufentanil,the rate of the compensatory analgesia,the first time to compress the analgesic pump,and the number of effective compressions within48 hours were recorded.We also recorded norepinephrine(NE),cortisol(Cor),and blood glucose(Glu)at admission time(T0),5 minutes after intubation(T1),the beginning of surgery(T2),30 minutes of surgery(T3)and the end of surgery(T4).We also recorded the interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and C-reactive protein(CRP)at 1 hour before surgery,2 hours after surgery,24 hours after surgery.Mean arterial blood pressure(MAP),heart rate(HR)at the time points of admission(T0),5 minutes after intubation(T1),at the beginning of surgery(T2),30 minutes of surgery(T3)and the end of surgery(T4),and the occurrence of postoperative nausea,vomiting,hypotension and pruritus were recorded as well.Results: There was no statistically significant difference between the two groups in demographic characteristics(P >0.05).Compared with Group G,patients in Group C had a higher 24-hour Qo R-15 score after surgery(P <0.05),a shorter residence time in the PACU(P <0.05),and reduce spontaneous breathing recovery time with a statistically significant difference(P <0.05).Compared with Group G,the VAS scores at 2 hours,24 hours and 48 hours were significantly lower in Group C(P <0.05).And the cumulative use of sufentanil was significantly lower in Group C(P <0.05).What’s more,the first time to compress the analgesic pump in Group C was later than patients in Group G(P <0.05).Compared with Group G,the levels of NE,Cor,and Glu were significantly lower in Group C at time points from T1 to T4(P< 0.05).Compared with Group G,the levels of IL-6,TNF-α,and CRP were significantly lower in Group C at 2h,24 h postoperatively(P < 0.05).Compared with Group G,patients in Group C had significantly lower values of MAP at T1 and T2,and lower values of HR at T1,differences were statistically significant(P < 0.05).While there was no statistical difference between the two groups at the rest of the time points(P > 0.05).The incidence of postoperative nausea was lower in Group C compared with Group G,(P <0.05),while there was no statistically significant difference in the incidence of postoperative vomiting,hypotension and pruritus between the two groups(P >0.05).Conclusion: The strategy that thoracic paravertebral nerve block combined with general anaesthesia improves postoperative recovery quality scores and promotes early postoperative rehabilitation in frail elderly patients.Nevertheless,the strategy that thoracic paravertebral nerve block combined with general anaesthesia reduce the postoperative pain in frail elderly patients undergoing thoracoscopic lobectomy,and reduce the cumulative use of sufentanil.Thoracic paravertebral nerve block combined with general anaesthesia inhibited the stress response and was more conducive to intraoperative hemodynamic stability in frail elderly patients undergoing thoracoscopic lobectomy.What’s more,thoracic paravertebral nerve block combined with general anaesthesia can inhibit the inflammatory response and nausea,which facilitates early postoperative rehabilitation in frail elderly patients.