Application of ultrasound-guided thoracic paravertebral block in enhanced recovery after surgery for video-assisted thoracoscopic surgery lobectomy: a clinical research

HU Jing; DING Yi; SHI Bi

doi:10.13820/j.cnki.gdyx.20184835

Abstract：Objective To investigate the effect of ultrasound-guided paravertebral nerve block (TPVB) on the perioperative recovery of patients undergoing thoracoscopic lobectomy (VATS). Methods Ninety patients for selected VATS lobectomy (ASA Ⅰ-Ⅲ) were randomly divided into parathoracic nerve block combined with general anesthesia group (Group P), epidural block combined with general anesthesia group (Group E) and simple general anesthesia group (Group G). TPVB (T5) was performed under ultrasound guidance before general anesthesia induction in Group P, epidural catheterization (T6-T7) were performed in Group E, and general anesthesia was performed in all the three groups. All patients were given with intravenous patient-controlled anesthesia (PCA) after operation. Thevital signs (MAP and HR) were recorded at entering the operation room (T1), during skin incision (T2) and before extubation (T3). VAS scores 6 hours (T4), 12 hours (T5) and 24 hours (T6) after operation during rest and cough. The adverse reactions (nausea, vomiting, drowsiness and restlessness) during analgesia, the use of PCA and the patient′s first feeding condition were also recorded. Results The MAPs at T1 and T2 were significant different between the (P＜0.05). The MAPs of the three groups were significantly different among the 3 groups (P＜0.05). At T3, MAP of Group G was significantly higher than those of Group P and E (P＜0.05). The MAP of Group G at T3 was significantly higher than that at T1 (P＜0.05). There was no significant difference of MAPs between Group P and E at T3 (P＞0.05). HR of Group E was significantly lower than that of Group P at T2 (P＜0.05). HR of Group G was significantly higher than that of Group E (P＜0.05). HR of Group E was significantly lower at T2 than T1 (P＜0.05). At T3, HR of Group G was significantly higher than those of Group E and P, (P＜0.05), though there was no significant difference in HR between Group P and E (P＞0.05). At T4, T5 and T6, the coughing VAS of Group P and E were significantly lower than those of Group G (P＜0.05), though there was no significant difference between Group P and E (P＞0.05). At T5 and T6, the rest VAS of Group P and E were significantly lower than those of Group G (P＜0.05), though there was no significant difference between Group P and E (P＞0.05). The incidence of postoperative nausea, vomiting, restlessness and lethargy in Group G was significantly higher than those in Group P and E (P＜0.05), and there was no significant difference between Group P and E (P＞0.05). The use of PCA in Group G was significantly more than those of Group P and E (P＜0.05), and there was no significant difference between Group P and E (P＞0.05). The time of first in Group G was significantly longer than those of Group P and E (P＜0.05), and there was no significant difference between Group P and E (P＞0.05). Conclusion Ultrasound-guided thoracic paravertebral nerve block is accurate and effective. It can reduce the stress reaction caused by noxious stimulation during perioperative period, optimize analgesia, reduce postoperative complications, and accelerate ERAS.