Application of thoracic paravertebral block combined with bronchial blocker placement in thoracoscopic surgery
10.3760/cma.j.cn341190-20240212-00169
- VernacularTitle:胸椎旁神经阻滞联合支气管阻塞导管在胸腔镜手术中的应用
- Author:
Dongmiao CAI
1
;
Qingxiang WANG
;
Haisong WANG
;
Shaoli LIN
;
Zhihong XU
Author Information
1. 厦门大学附属第一医院麻醉手术科（厦门市麻醉医疗质量控制中心），厦门 361000
- Keywords:
Thoracoscopy;
Bronchi;
Nerve block;
Ultrasonography;
Rehabilitation;
Analgesia;
Inflammation mediators;
Hemodynamics
- From:
Chinese Journal of Primary Medicine and Pharmacy
2024;31(11):1666-1671
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical value of ultrasound-guided thoracic paravertebral block (TPVB) combined with bronchial blocker (BB) placement in thoracoscopic surgery.Methods:A randomized controlled study was conducted involving 60 patients scheduled for thoracoscopic surgery at The First Affiliated Hospital of Xiamen University from November to December 2023. These patients were classified as American Society of Anesthesiologists (ASA) I-II. They were divided into an observation group (BB placement) and a control group (double-lumen bronchial blocker placement) using the random number table method, with 30 patients in each group. Preoperatively, TPVB was performed under ultrasound guidance. After the induction of general anesthesia, a single-lumen tracheal tube was inserted, followed by the placement of a BB in the observation group, while a corresponding type of double-lumen bronchial tube was inserted in the control group. A fiberoptic bronchoscope was used for positioning and fixation in both groups, and anesthesia was maintained with intravenous anesthesia. The following parameters were assessed in each group: positioning time for intubation; number of cases with tube displacement; number of cases of postoperative pharyngeal pain; hemodynamic parameters [mean arterial pressure (MAP) and heart rate (HR)] before and after intubation; and blood gas analysis [partial pressure of oxygen (PaO 2) and carbon dioxide (PaCO 2)]. Additionally, the surgical field exposure score and the dosages of propofol and remifentanil administered during surgery were recorded. Levels of inflammatory markers [interleukin (IL)-2, IL-4, IL-6, IL-10, tumor necrosis factor (TNF) -α, and TNF-β] and Visual Analog Scale scores for pain at rest and during cough, recorded at 2, 4, 8, 10, 12, and 24 hours postoperatively were compared between the two groups. Results:The total amounts of propofol [(569.7 ± 29.2) mg] and remifentanil [(289.3 ± 46.3) μg] in the observation group were significantly lower than those in the control group [(612.6 ± 28.7) mg, (361.7 ± 40.6) μg, t = 5.74, 6.44, both P = 0.001]. The recovery time in the observation group [(31.8 ± 11.4) minutes] was significantly shorter than that in the control group [(37.5 ± 10.1) minutes, t = 2.10, P = 0.040]. There was no significant difference in positioning time for intubation between observation and control groups [(67 ± 13) seconds vs. (80 ± 36) seconds, t = 1.86, P = 0.068). There was no significant difference in percentage of cases who underwent tube displacement after intubation between observation and control group [23.3% (7/30) vs. 16.7% (5/30), χ2 = 0.58, P = 0.445]. The incidence of postoperative pharyngeal pain in the observation group was significantly lower than that in the control group [10.0% (3/30) vs. 33.3% (10/30), χ2 = 5.02, P = 0.025). There were no statistically significant differences between the two groups in terms of number of cases with tube displacement, hemodynamic parameters, blood gas analysis, inflammatory markers, surgical field exposure, and postoperative Visual Analog Scale scores between the two groups (all P > 0.05). Conclusion:Ultrasound-guided TPVB combined with BB placement during thoracoscopic surgery can reduce airway injury compared with the use of a double-lumen bronchial tube. It provides adequate sedation and analgesia during the procedure, facilitates rapid awakening, promotes early recovery of spontaneous breathing, and has fewer adverse reactions, making it worthy of clinical promotion.
