Clinical effect of ultrasound-guided thoracic paravertebral nerve block on anesthesia and postoperative analgesia in patients undergoing radical resection of lung cancer

Abstract

Objective To observe the clinical effect of ultrasound-guided thoracic paravertebral nerve block on anesthesia and postoperative analgesia in patients undergoing radical resection of lung cancer. Methods From August 2016 to August 2018, 88 patients who had undergone selective radical resection of lung cancer in the Traditional Chinese Medicine Hospital of Jinhua were divided into study group and control group according to random number table, with 44 cases in each group.The patients in the control group were given epidural block combined with general anesthesia.The patients in the study group were given ultrasound-guided thoracic paravertebral nerve block combined with general anesthesia.The hemodynamic parameters such as SpO2, MAP and HR were monitored before and after anesthesia(T0), after blocking anesthesia administration(T1), after induction and extubation(T2), after skin incision(T3) and extubation(T4). The serum levels of NE, Cro, hs-CRP and TNF-α were measured before and after operation.The VAS scores were scored at different time points after operation.The adverse reactions after anesthesia were observed. Results The values of MAP and HR at each time point of T1-T4 in the control group were significantly lower than those at T0(t=5.067-14.839, all P 0.05). At 6h, 12h, 24h and 48h after operation, the levels of serum NE, Cro, hs-CRP and TNF-α in both two groups were significantly higher than those before operation(t=16.289-38.520, all P<0.05), and the levels of serum NE, Cro, hs-CRP and TNF-α in the study group were significantly lower than those in the control group at all time points after operation(t=4.925-12.162, all P<0.05). The VAS scores of resting state and cough state at different time points in the study group were significantly lower than those in the control group(t=6.593-8.424, all P<0.05). The overall incidence of adverse reactions in the study group[18.18%(8/44)] was significantly lower than that in the control group[38.64%(17/44)](χ2=4.526, P=0.033). Conclusion Compared with epidural anesthesia, ultrasound-guided thoracic paravertebral nerve block combined with general anesthesia can effectively maintain the stability of blood flow, reduce the level of post-operative stress and inflammatory reaction, alleviate the degree of post-operative pain response, and prevent the occurrence of adverse reactions after anesthesia, which is worthy of clinical application. Key words: Ultrasonography; Anesthesia, epidural; Nerve block; Lung neoplasms; Pulmonary surgical procedures; Hemodynamics; Analgesia