Effect of bilateral thoracic paravertebral block on inflammatory response caused by extracorporeal circulation in patients undergoing mitral valve replacement

Sun Li-xin; Pan Wei-wei; Wang Ming-shan; Shi Fei

doi:10.13498/j.cnki.chin.j.ecc.2014.03.18

Abstract：Objective To investigate the effect of bilateral thoracic paravertebral block on inflammatory response caused by ex-tracorporeal circulation ( ECC) in patients undergoing mitral valve replacement. Methods Fifty six patients scheduled for mitral valve replacement were randomly divided into two groups ( n=28 in each):bilateral thoracic paravertebral block combined with general anes-thesia group ( group P ) and pure general anesthesia group ( group G ) . Bilateral thoracic paravertebral block and insertion epidural catheter were performed at T3, T4 interspace prior to induction of anesthesia in group P. A test dose of 5 ml of 0.375% ropivacaine was injected through the catheter in two sides;then a bolus dose of 15 ml of 0.375% ropivacaine was injected 5 min later. Blood samples were taken to determine the serum IL-6, IL-8 and TNF-αconcentration before ECC, at the end of operation, postoporative 12 h and 24 h respectively. Clinical data including parameters of heart resuscitation, dosages of positive inotropic agent, time of mechanical ven-tilation and ICU stay, rate of pneumonia, heart failure and death were recorded. Results The levels of the serum IL-6, IL-8 and TNF-αafter operation in both groups were significantly higher than those before ECC ( P<0.05-P<0.01) . There was no significant differ-ence in the level of the serum IL-6 between two groups at postoporative 24 h ( P>0.05);compared with group G, the levels of the serum IL-6, IL-8 and TNF-αwere significantly lower in group P ( P<0.05) at the other points. Dosages of positive inotropic agent, time of mechanical ventilation and rate of heart failure in group P were significantly lower than those in group G ( P<0.05).Conclusion Bilat-eral thoracic paravertebral block can decrease the level of inflammatory factor caused by ECC in patients undergoing mitral valve replace-ment.