Abstract
Objective To evaluate the efficacy of paravertebral block for preemptive analgesia in elderly patients undergoing thoracotomy. Methods Sixty patients, aged 65-70 yr, with body mass index of 18-23 kg/m2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective radical resection for esophageal cancer through a left thoracotomy, were randomly divided into total intravenous anesthesia group (group I) and total intravenous anesthesia combined with paravertebral block group (group B) with 30 patients in each group.Anesthesia was induced with iv infusion of dexmedetomidine 0.4 μg·kg-1·h-1, and iv injection of midazolam 0.04 mg/kg, propofol 2 mg/kg, sufentanil 0.5 μg/kg and rocuronium 0.8 mg/kg.In group B, paravertebral block was performed under the guidance of altrasound after induction of anesthesia, a paravertebral catheter was placed at T4-8 in the paravertebral space on the left side, and 0.5% ropivacaine 5 ml was injected via the catheter into the paravertebral space.Anesthesia was maintained with iv infusion of propofol 6-8 mg·kg-1·h-1 and remifentanil 0.1-0.3 μg·kg-1·min-1, and intermittent iv blouses of rocuronium.Patient-controlled intravenous analgesia (PCIA) was used after operation.PCIA solution contained sufentanil 2 μg/kg, dezocine 10 mg, and dexmedetomidine 100 μg in 100 ml of normal saline.The PCIA pump was set up with a 2 ml bolus dose, a 15 min lockout interval, and background infusion at a rate of 2 ml/h.Prince-Henry score was maintained ≤ 3 after operation.At 5 min before skin incision, 5 min after skin incision, and 5 min after thoracotomy, the mean arterial pressure and heart rate were recorded.The intraoperative consumption of anesthetics, the extubation time, SpO2 at 30 min after extubation, amount of drugs consumed per hour during PCIA, occurrence of postoperative pulmonary complications, patients who required intensive care unit admission, and postoperative recovery time were recorded. Results No cardiovascular events were found in the two groups.Compared with group I, the intraoperative consumption of propofol, remifentanil and rocuronium was significantly decreased, extubation time was shortened, the SpO2 at 30 min after extubation was increased, the amount of drugs consumed per hour during PCIA was reduced, the incidence of postoperative complications and the number of patients who required ICU admission were decreased, and the postoperative recovery time was shortened in group B (P<0.05). Conclusion Paravertebral block produces good efficacy for preemptive analgesia in elderly patients undergoing thoracotomy. Key words: Nerve block; Analgesia; Aged; Thoracotomy
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