| Objective To compare the efficacy of ultrasound-guided thoracic paravertebral nerve block (TPVB) and thoracic approach to TPVB performed via the surgical field on intraoperative anesthesia management and postoperative analgesia in patients undergoing single-port video-assisted thoracoscope(VATS) lobectomy. Methods A total of 60 patients of both sexes, aged 39-65 yr, of American Society of Anesthesiologists Physical Status (ASA) I to Ⅲ, scheduled for VATS lobectomy, were divided randomly into two groups using a random number table method:ultrasound-guided TPVB group (group P) and thoracic TPVB group (group I),30 of each. In group P, patients underwent ultrasound-guided TPVB before surgery, while TPVB was performed before closing the chest by the surgeon in group I, and 0.375% ropivacaine 20mL was injected. Then general anesthesia and patient-controlled intravenous analgesia (PCIA) were performed in both groups. The time period to perform the blocks, the numbers of anesthetized dermatomes, hemodynamics,total remifentanil and propofol uesd during operation time, the postoperative pain scores and sulfentanil consumption were recorded. Visual analogue score (VAS) was recorded at 1, 2, 4, 6, 8, 12, 24, 48 hour after surgery. The occurrence of irritability, pneumothorax, paravertebral hematoma and patient satisfaction were also recorded. Results Compare with group I, the time period to perform the blocks of group P were longer (P<0.05). The numbers of anesthetized dermatomes in group P were less postoperatively (P<0.05) while the hemodynamics changed smoothly during surgery (P<0.05). The total dosage of remifentanil and propofol, extubation time, and time in PACU were more (P<0.05). In group P the occurrence of paravertebral hematoma was higher than that of group I (P<0.05). There existed no differences in VAS at rest or movement, sulfentanil consumption, nor the patients' satisfaction (P>0.05). Conclusions Both ultrasound-guided TPVB and thoracic approach to TPVB can enhance the efficacy of postoperative analgesia in patients undergoing lobectomy. Preoperative ultrasound-guided TPVB reduces the amount of anesthetics for patients, which is beneficial to the intraoperative anesthesia management of patients, and the recovery is faster, but it may cause chest wall bleeding. While thoracic approach to TPVB could avoid the risk of repeated puncture and accidental injection of blood. Anesthetists may weigh pros and cons before choosing the more appropriate solution. |
