Effect of bilateral thoracic paravertebral block combined with general anesthesia on early recovery after Nuss procedure in patients with pectus excavatum / 中华麻醉学杂志

ABSTRACT

Objective To evaluate the effect of bilateral thoracic paravertebral block (TPVB) combined with general anesthesia on early recovery after Nuss procedure in patients with pectus excavatum.Methods Sixty patients of both sexes with pectus excavatum,aged 8-18 yr,with body mass index＜ 18.5-32.0 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective Nuss procedure,were divided into 2 groups by using a random number table method:general anesthesia group (group GA,n=30) and bilateral TPVB combined with general anesthesia group (group TPVB+ GA,n=30).Bilateral TPVB was performed at the level of T5 under ultrasound guidance at 30 min before operation in group TPVB+GA.Anesthesia was induced by intravenous injection of fentanyl,propofol and rocuronium and maintained by inhalation of sevoflurane,intravenous infusion of remifentanil 0.1-0.5 μg · kg-1 · min-1,and intermittent intravenous boluses of rocuronium.Patients received patient-controlled intravenous analgesia after operation.Tramadol 1-2 mg/kg or dizocin 0.1 mg/kg was intravenously injected as rescue analgesic,maintaining visual analogue scale score ≤ 3 within 2 days after operation.The intraoperative consumption of remifentanil,postoperative consumption of snfentanil,requirement for rescue analgesia and development of nausea and retching/vomiting were recorded.Quality of recovery was assessed using the Quality of Recovery-15 at 1 and 2 days after operation.Results Compared with group GA,the intraoperative consumption of remifentanil,postoperative consumption of sufentanil,rate of rescue analgesia and incidence of nausea and vomiting were significantly decreased,and Quality of Recovery-15 scores were increased at 1 and 2 days after operation in group TPVB +GA (P＜0.05).Conclusion Bilateral TPVB combined with general anesthesia can reduce the perioperative consumption of opioids and is beneficial for the early recovery after Nuss procedure in patients with pectus excavatum.