[Application of thoracoscopy guided thoracic paravertebral block for analgesia after single port video assisted pulmonary lobectomy]
Objective: To investigate the effects of thoracoscopy guided thoracic paravertebral block for analgesia after single port video assisted pulmonary lobectomy. Methods: From December 2019 to April 2020, 60 patients receiving single port video assisted pulmonary lobectomy at Ningbo Medical Center Lihuili Hospital were selected. The patients were randomly and equally divided into control group and paravertebral block group using a random number table. Patients of paravertebral block group were injected into the thoracic 4 5 intercostal, paravertebral 1 cm using 0.375% ropivacaine (20 ml) with thoracoscopy guided at the end of surgery, while patients of control group were given patient controlled intravenous analgesia (PCIA) Postoperative visual analogue scale (VAS) and Ramsay sedation scale were recorded at 6, 12, 24, 36, 48 h after the surgery. The incidence of postoperative adverse reactions, additional dose and times of pethidine, the time to resume eating, the rate of postoperative active cough, the first time to get out of bed after surgery and postoperative hospital stay of two groups' patients were recorded. t test and chisquare test were used for statistical analysis. Results: The VAS score of paravertebral block group were lower than those of control group at all time points (all P<0.05) The Ramsay sedation scale of paravertebral block group were higher than those of control group at all time points (all P<0.05) The additional dose and times of pethidine of paravertebral block group were (8.2+ 2.3) mg and (0.2+ 0.1) time, which were lower than (87.8+ 15.3) mg and (1.8+ 0.3) time of control group, the differences were statistically significant (t=28.91, 34.37, all P<0.05) Incidence of nausea, vomiting and pruritus of paravertebral block group were 10.0% 6.7% and 0, which were lower than 40.0% 30.0% and 13.3% of control group, the differences were statistically significant (kh(2)=7.20, 5.45, 4.29, all P<0.05) The rate of postoperative active cough of paravertebral block group was 33.3% which was higher than 10.0% of control group, the difference was statistically significant (kh(2)=4.81, P<0.05) The time to resume eating, the first time to get out of bed after surgery and postoperative hospital stay were (6.5+ 0.4) h, (20.9+ 3.1) h and (4.6+ 1.0) d, which were lower than (8.5+ 0.7) h, (28.6+ 4.8) h and (6.1+ 1.3) d of control group, the differences were statistically significant (t=13.47, 7.39, 4.19, all P<0.05) Conclusion: Thoracic paravertebral block under thoracoscopy guided can effectively reduce the postoperative pain of single port thoracoscopic lobectomy, with fewer adverse reactions, and is beneficial to postoperative recovery.
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