Application of multimodal analgesia in video-assisted thoracoscopic lobectomy

Abstract

Objective To investigate whether the use of flurbiprofen axe combined with B-ultrasound guided paravertebral nerve block in thoracoscopic lobectomy can improve the analgesic effect, inhibit the body's stress response, reduce the dosage and side effects of opioids. To further test whether the results of the study are related to ropivacaine hydrochloride concentration. Methods Sixty patients undergoing thoracoscopic lobectomy were randomly divided into 3 groups(n=20). Control group was given Flurbiprofen axetil 50 mg 30 min before induction and also give same dose 30 min before sewing, low concentration combined group was given 0.375% ropivacaine paravertebral block+Flurbiprofen axetil (in the same way as the control group), high-concentration combination group was given 0.5% ropivacaine paravertebral block+Flurbiprofen axetil (in the same way as the control group). All patients were given to patient-controlled intravenous analgesia(PCIA) after operative. Observing the recovery situation, Numerical Rating Scale (NRS) scores at rest time and during cough after postoperative, analgesia adverse reactions; recording remifentanil dosage and the total number of compressions PCIA after operative, the determination of cortisol (Cor) and β-endorphin (β-EP) concentrations. Results The incidence of restlessness and restlessness scores in the control group were significantly higher than other two groups (P 0.05). Compared with the low-dose group, the NRS score at rest and the time of coughing in the high-dose group were significantly lower at the 24 h after operation (P 0.05). There was no significant difference of the Cor and β-EP concentration in the preoperative and postoperative between the three groups (P>0.05). Compared with the control group, the concentration of Cor and β-EP were significantly low at 6 and 12 hours in the other two groups (P 0.05). There was no significant difference in the preoperative and postoperative Cor and β-EP levels among the three groups (P>0.05). Compared with the control group, the Cor and β-EP levels in the other two groups were significantly low at 6 h and 12 h (P 0.05). The concentration of Cor and β-EP was increased significantly at 6 h and 12 h after surgery in the control group (P<0.05). Conclusions Thoracic paravertebral block with 0.5% ropivacaine combined with flurbiprofen axetil for thoracoscopic lobectomy provides more effective analgesia, prolongs analgesia time, reduces opioid use and side effects, and inhibits body stress response. As a result, thoracic paraveterbral block achieves the purpose of accelerating post-operative rehabilitation of this type of surgery. Key words: Multimodal analgesia; Flurbiprofen Axetil; Ultrasound; Ropivacaine; Thoracoscopic lobectomy