Effects of lateral and medial points of thoracic paravertebral nerve block by ultrasound for rapid recovery after laparoscopic cholecystectomy

Abstract

Objective: To investigate the effects of ultrasound-guided lateral and medial point blocks of thoracic paravertebral space on the rapid recovery of laparoscopic cholecystectomy. Methods: A total of 90 patients of either sex, aged 18-67 years, weighted 45.10-91.80 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing elective laparoscopic cholecystectomy were divided into two groups (n=45) using a random number table: lateral point group of thoracic paravertebral space (group A) and medial point group of thoracic paravertebral space (group B). Ultrasound-guided thoracic paravertebral nerve block was performed before induction of general anesthesia. The puncture point of group A was positioned as the intercostal block of the thoracic paravertebral space of the right side of T(6)-T(11), and the puncture point of the group B was positioned as the thoracic paravertebral body of the right side of T(6)-T(11) thoracic paravertebral space. The thoracic paravertebral block was performed with 2 ml of 0.75% ropivacaine per injection for a total of 10 ml. The visual analog scale (VAS) scores of resting pain and active pain at 4, 8, 12 and 24 h after operation were observed. The anus recovery time after surgery and perioperative hypotension were also recorded. Results: The blood pressures in group A were significantly higher than those in group B at 4, 8, 12 and 24 h after operation, which were(73±7) vs (70±7), (78±7) vs (74±7),(82±7) vs (79±7),and (87±7) vs (83±7) mmHg,and the differences were statistically significant (t=2.29, 2.54, 2.33, 2.37, all P<0.05). The VAS scores of resting pain and active pain in group A were significantly higher than those in group B, and the differences were statistically significant (Z=-2.29, -2.51, -2.21, -2.39, -2.53, -2.25, -2.30, -2.24, all P<0.05). The postoperative anal exhaust recovery time of the patients in group A was (21.8±1.9) min that was obvious lower than that in group B which was (22.7±1.9) min with statistically significant difference (t=2.12, P<0.05). There was no significant difference in the incidence of postoperative dizziness, nausea, vomiting, and pruritus (χ(2)=0.28, 0.72, 0.45, 0.21,all P>0.05). Conclusions: In the procedure of thoracic paravertebral block under the guidance of ultrasound, the closer blocking points are to the central axis of the spine, the better the postoperative analgesic effect, but the more obvious the postoperative blood pressure reduction and the longer the anal recovery exhaust time. The further away from the central axis of the spine, the more analgesic effect decreases, but the blood pressure decreases and the anal recovery time is relatively rapid.