超声引导下竖脊肌平面阻滞和胸椎旁神经阻滞对胸腔镜 手术患者应激反应和镇痛效果的比较.

To evaluate the effects of ultrasus-guided thoracic paravertebral nerve block (TPVB) and erectile spinal-plane block (ESPB) on perioperative stress response and analgesia in patients undergoing thoracoscopic surgery. Methods Ninety patients underwent thoracoscopic surgery under elective general anesthesia were included and randomly divided into the control group (group C), the ESPB group (group E) and the TPVB group (group T), with 30 cases in each group. Before anesthesia induction, no treatment was given to the group C, and the group E and the group T were treated with ultrasound guided ESPB and TPVB on the affected side, and injected with 20 mL of 0.5% ropivacaine. Patient controlled analgesia (PCIA) was connected after operation. The venous blood samples were collected immediately before operation (T0), 30 minutes after operation (T1) and at the time of tracheal catheter removal (T2) to test the concentration of blood glucose (Glu) and serum cortisol (Cor). The type of surgery, the duration time of surgery, the number of patients who needed to use phenylephrine and the amount of remifentanil for hypotension during operation were recorded. Visual analog scores (VAS) of patients at rest and coughing status at T2, 12 hours after operation (T3), 24 hours after operation (T4), 48 hours after operation (T5), the total number of PCIA compression and the total amount of PCIA sufentanil infusion within 48 hours after operation, the use of rescue analgesia, and the occurrence of adverse reactions were recorded. Results Compared with T0, concentrations of Cor and Glu at T1 and T2, were increased in patients (P＜0.05). Compared with the group C, Glu was significantly decreased in the group T, the resting VAS pain scores of T2, T3, T4 and T5 were decreased in the group T and the group E. The coughing VAS pain scores of T2 and T4 were decreased, and the intraoperative dosage of reifentanil, the number of PCIA compression and the total infusion of sufentanil were decreased. The remedial analgesic rate was decreased in the T group (P＜0.05). Compared with the group T, the resting VAS scores of T2, T3 and T4 were increased in the group E, and the coughing VAS scores of T3 were increased, the number of PCIA compression, remifentanil usage and the total infusion of PCIA sufentanil were increased. The percentage of intraoperative use of norepinephrine for hypotension was decreased (P＜ 0.05). Conclusion TPVB can inhibit the stress response of patients undergoing thoracoscopic surgery. TPVB could provide better postoperative analgesia than ESPB, and has a significant inhibitory effect on intraoperative blood pressure. [ABSTRACT FROM AUTHOR]