Perioperative application of thoracic paravertebral nerve block combined with general anesthesia in elderly patients with non-small cell lung cancer / 中国医师杂志

ABSTRACT

Objective To investigate the effect of thoracic paravertebral nerve block combined with general anesthesia in the perioperative period of elderly patients with non-small cell lung cancer (NSCLC).Methods 50 elderly patients with NSCLC in our hospital from June 2015 to June 2018 were randomly divided into control group (n =25) and observation group (n =25).The control group was given general anesthesia,while the observation group was given thoracic paravertebral nerve block combined with general anesthesia.Postoperative recovery (recovery time,extubation time,ambulation time,feeding time) and hospitalization time,visual analogue scale (VAS) score at 2,12,24 and 48 hours after operation,serum tumor markers [cyfra21-1],carbohydrate antigen 125 (CA125),CA199,carcinoembryonic antigen (CEA) were counted and compared.The heart rate (HR),mean arterial pressure (MAP) [preoperative (T1),15 minutes (T2),5 minutes (T3) after anesthesia],and the incidence of adverse reactions were recorded.Results (1) Postoperative recovery and hospitalization timehospitalization time,recovery room stay time,extubation time,out-of-bed activity time and eating time of the observation group were shorter than those of the control group (P ＜ 0.05);(2) Pain degreeVAS score of the observation group was lower than that of the control group at 2,12 and 24 hours after operation (P ＜0.05),and 48 hours after operation VAS score of the observation group was lower than that of the control group (P ＜ 0.05).There was no significant difference between the two groups (P ＞ 0.05);(3) Serum tumor markersthere was no significant difference in serum cyfra21-1,CA125,CA199 and CEA levels between the two groups before operation (P ＞ 0.05).After operation,serum cyfra21-1,CA125,CA199 and CEA levels of the two groups were decreased,and the indexes in observation group were lower than that of the control group (P ＜ 0.05);(4) Hemodynamicsthere was no significant difference in HR and MAP between the two groups at T1 (P ＞ 0.05).HR and MAP in the two groups at T2 were lower than those at T1,but the levels of each index in the observation group were higher than those in the control group (P ＜ 0.05).HR and MAP in the observation group at T3 stage returned to the level at T1,and there was significant difference between the two groups (P ＜0.05);(5) Adverse reactionsthe incidence of adverse reactions in the observation group (8.0％) was lower than that in the control group (32.0％,P ＜ 0.05).Conclusions The application of thoracic paravertebral nerve block combined with general anesthesia in total thoracoscopic lobectomy is safe and can inhibit the large fluctuation of hemodynamics in elderly patients with non-small cell lung cancer,shorten hospitalization time and post-operative rehabilitation time,alleviate post-operative pain,reduce the content of serum tumor markers,and reduce the risk of adverse reactions.