胸椎旁神经阻滞对胸腔镜肺癌根治术患者术后痛觉过敏的影响

目的 观察胸椎旁神经阻滞对胸腔镜肺癌根治术患者术后痛觉过敏的影响.方法 选择行单孔胸腔镜肺癌根治术患者60例,男27例,女33例,年龄18～75岁,BMI 18.5～30.0 kg/m2,ASAⅠ或Ⅱ级.采用随机数字表法将患者随机分为两组:对照组(C组)和全麻联合胸椎旁神经阻滞组(T组),每组30例.麻醉诱导前,T组于...

Effect of thoracic paravertebral block on postoperative hyperalgesia in patients undergoing thoracoscopic radical resection of lung cancer

Objective To observe the effect of thoracic paravertebral block(TPVB)on postoperative hyperalgesia in patients undergoing thoracoscopic radical resection of lung cancer.Methods Sixty patients scheduled for single-incision thoracoscopic radical resection of lung cancer,27 males and 33 females,aged 18-75 years,BMI 18.5-30.0 kg/m²,ASA physical statusⅠorⅡ,were randomly divided into the following two groups by random number table method:control group(group C)and general anesthesia combined with TPVB group(group T),30 patients in each group.TPVB in T_4-5 and T_6-7 thoracic paravertebral spaces were implemented before the induction of general anesthesia in group T,while 0.33%ropivacaine 15 ml were injected into each thoracic paravertebral space.The same amount of normal saline was injected into the same thoracic paravertebral spaces in group C.Subsequently,all patients underwent general anesthesia by sevoflurane and remifentanil.Mechanical pain thresholds were measured using Von Frey filaments 24 hours before surgery,24 and 48 hours after surgery.Numerical rating scale(NRS)scores were recorded at 0.5,1,2,6,12,24,and 48 hours postoperatively.Other variables,including intraoperative dosage of sevoflurane and remifentanil,post-anesthesia care unit(PACU)retention time,number of rescue analgesia in PACU,cumulative consumption of analgesic pump liquid,number of effective pressing of analgesic pump within 24 hours postoperatively,first time of pressing analgesic pumps,and patient satisfaction regarding postoperative analgesia were recorded.Adverse reactions such as nausea,vomiting,excessive sedation,hypoxemia and hypotension were recorded within 48 hours after operation.Results Mechanical pain thresholds in group T were higher than those in group C 24 and 48 hours after surgery(P<0.05).NRS scores in group T were lower than those in group C 0.5,1,2,6,12 hours after surgery,no matter in motion or at rest(P<0.05).Compared with group C,total consumption of intraoperative dosage of remifentanil,PACU retention time,number of rescue analgesia,cumulative consumption of analgesic pump liquid and analgesic pump effective pressing times within 24 hours postoperatively were less in group T(P<0.05).The first time of pressing the analgesia pump was later in group T than in group C(P<0.05).Patient satisfaction regarding postoperative analgesia was higher in group T than in group C(P<0.05).With respect to adverse effects up to 48 hours postoperatively,differences between the two groups were not significant.Conclusion TPVB can alleviate postoperative hyperalgesia in patients who underwent thoracoscopic radical resection of lung cancer,reduce perioperative opioids consumption,and further improve patient satisfaction regarding postoperative analgesia.