Modifiying efficacy of thoracic paravertebral block combined with general anesthesia in patients un-dergoing single-port video-assisted thoracoscopic radical operation for lung cancer / 中华麻醉学杂志

ABSTRACT

Objective To evaluate the modifying efficacy of thoracic paravertebral block ( TPVB) combined with general anesthesia in the patients undergoing single-port video-assisted thoracoscopic radical operation for lung cancer. Methods Sixty-six American Society of Anesthesiologists physical status Ⅰ orⅡ patients of both sexes, aged 18-64 yr, with body mass index of 20-24 kg∕m2 , undergoing elective sin-gle-port video-assisted thoracoscopic radical resection of lung cancer, were divided into TPVB plus general anesthesia group ( group TPVB+GA, n=33) and general anesthesia group ( group GA, n=33) using a random number table method. Ultrasound-guided TPVB was performed at T4 and T7 before induction of gen-eral anesthesia, and 0. 5％ ropivacaine 10 ml was injected into the two sites. General anesthesia was in-duced with midazolam, etomidate, sufentanil and rocuronium. Anesthesia was maintained by inhaling sevoflurane and infusing remifentanil. Patient-controlled intravenous analgesia ( PCIA ) with fentanyl 2μg∕kg, flurbiprofen 100 mg and 10 mg in 100 ml of normal saline. Sufentanil 0. 1μg∕kg was intravenously injected when VAS score≥4 during postanesthesia care unit ( PACU) . Propofol 0. 5-1. 0 mg∕kg was intra-venously injected when Sedation-Agitation Scale scores>5 during PACU. Nicardipine 0. 2 mg was injected intravenously when mean arterial pressureheart was increased by 30％ of baseline value during PACU. Es-molol 20 mg was given inravenously when heart rate was>100 bpm during PACU. The end-tidal concentra-tion of sevoflurane was recorded at 5 min after incision and at 5, 20, 30 and 60 min after inserting thoraco-scopic cannula. Venous blood samples were collected before operation, at 5 min after inserting thoracoscop-ic cannula, at closing chest and at 6 and 24 h after operation for determination of plasma norepinephrine concentrations by enzyme-linked immunosorbent assay. The consumption of remifentanil during opertion, requirement for sufentanil, propofol, nicardipine and esmolol during PACU, duration of PACU stay and development of postoperative nausea and vomiting were recorded. Results Compared with group GA, the intraoperative end-tidal concentration of sevoflurane and consumption of remifentanil were significantly re-duced, the concentration of norepinephrine was decreased at each time point during and after surgery, and the requirement for sufentanil, propofol, nicardipine and esmolol was decreased during PACU, and dura-tion of PACU stay was shortened during stay in PACU in group TPVB+GA ( P<0. 05) . Postoperative nause-a and vomiting was not found in the two groups. Conclusion TPVB combined with general anesthesia is helpful in carrying out anesthetic model of low-consumption opioids and in improving the quality of recovery from anesthesia and is more helpful in inhibiting intraoperative and postoperative stress responses and post-operative pain responses than general anesthesia alone when used for the single-port video-assisted thoraco-scopic radical operation for lung cancer.