Effect of thoracic paravertebral block on intraoperative hypotension in patients undergoing thoracoscopic lung surgery under general anesthesia
10.3760/cma.j.cn131073.20191020.00504
- VernacularTitle:胸椎旁神经阻滞对全麻胸腔镜肺部手术患者术中低血压的影响
- Author:
Ran ZHANG
1
;
Jia JIN
;
Long TIAN
;
Fei HUO
;
Yi FENG
Author Information
1. 北京大学人民医院麻醉科 100044
- From:
Chinese Journal of Anesthesiology
2020;40(5):528-532
- CountryChina
- Language:Chinese
-
Abstract:
The data of patients of both sexes, aged ≥ 18 yr, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, underwent thoracoscopic lung surgery under general anesthesia from January 2017 to December 2017, were retrospectively collected.The patients were divided into 2 groups according to whether they received thoracic paravertebral block (PVB) before operation: general anesthesia group (group G) and thoracic PVB combined with general anesthesia group (GP group). T 3/T 4 and T 6/T 7 double point thoracic PVB was performed under ultrasound guidance before anesthesia induction in GP group.Anesthesia was induced with sufentanil, propofol/etomidate and cisatracurium and maintained with propofol, remifentanil, cisatracurium and dexmedetomidine during operation.According to whether sufentanil was added before skin incision, patients received thoracic PVB combined with general anesthesia were divided into 2 subgroups: increment of sufentanil group and non-increment of sufentanil group, and a 1∶1 propensity score matching was performed in two groups.The usage of vasopressor drugs, amount of opioids consumed, volume of fluid infused, urine volume, blood loss and operation time were recorded.Compared with group G, the intraoperative urine volume, volume of fluid infused, and requirement for vasopressor drugs after skin incision were increased, and the intraoperative consumption of remifentanil was reduced in group GP ( P<0.05). Before matching, compared with non-increment of sufentanil group, the consumption of sufentanil at induction, intraoperative blood loss, volume of fluid infused and urine volume were significantly increased, and the operation time was prolonged in increment of sufentanil group ( P<0.05). After matching, compared with non-increment of sufentanil group, the requirement for vasopressor drugs was significantly increased in increment of sufentanil group ( P<0.05). In conclusion, thoracic PVB can increase the incidence of intraoperative hypotension in the patients undergoing thoracoscopic lung surgery under general anesthesia, and the reason may be related to the thoracic PVB-induced direct inhibition of sympathetic nerves and to opioids usage.
