Effect of thoracic approach to thoracic paravertebral blockade performed via video-assisted thoracoscope on postoperative analgesia in patients undergoing lobectomy

Abstract

Objective To evaluate the efficacy of the thoracic approach to thoracic paravertebral blockade (PVB) performed via video-assisted thoracoscope on postoperative analgesia in patients undergoing lobectomy. Methods A total of 84 patients of both sexes, aged 44-64 yr, with body mass index of 19.7-24.9 kg/m2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective video-assisted thoracoscopic unilateral lobectomy, were divided into 2 groups (n=42 each) using a random number table method: thoracic PVB group (TP group) and control group (C group). In TP group, the thoracic approach to thoracic PVB was performed on the affected side via video-assisted thoracoscope before closing the chest, and 0.375% ropivacaine hydrochloride 20 ml was injected.Then patient-controlled intravenous analgesia (PCIA) was performed in both groups.PCIA solution contained dezocine 0.6 mg/kg, flurbiprofen axetil 200 mg, palonosetron 0.5 mg and dexamethasone 10 mg in 120 ml of normal saline.The PCA pump was set up with a 0.5 ml bolus dose, a 15 min lockout interval and background infusion at a rate of 2 ml/h after a loading dose of 5 ml.Duration of operation was recorded.The peak expiratory flow rate (PEFR) was recorded before surgery and at 6, 24 and 48 h after surgery.The amount of dezocine and pressing times of PCA were recorded at 24 and 48 h after surgery.The occurrence of drowsiness, dizziness, nausea and vomiting was recorded after surgery.Tramadol 2 mg/kg was intravenously injected as rescue analgesic when visual analog scale score≥4 points. Results Compared with group C, the amount of dezocine and pressing times of PCA were significantly reduced at 24 and 48 h after surgery, the requirement for rescue analgesia and incidence of nausea and vomiting were decreased, and the PEFR was increased at 6 h after operation in group TP (P<0.05). Conclusion The thoracic approach to PVB performed via video-assisted thoracoscope can enhance the efficacy of postoperative analgesia in patients undergoing lobectomy. Key words: Nerve block; Pain, postoperative; Thoracoscopy