Effect of nalbuphine combined with rhomboid intercostal block on acute hyperalgesia after video-assisted thoracoscopic lobectomy
Objective To explore the effect of nalbuphine combined with rhomboid intercostal block(RIB)on acute hyperalgesia after video-assisted thoracoscopic lobectomy.Methods A total of 96 patients with non-small cell lung cancer who underwent video-assisted thoracoscopic lobectomy in Hanzhong Central Hospital from February 2021 to March 2023 were prospectively selected and were divided into group A,B,and C with 32 cases in each group by the random number table method.Group A included 18 males and 14 females,aged(64.25±7.41)years.Group B included 20 males and 12 females,aged(64.89±7.56)years.Group C included 16 males and 16 females,aged(65.18±7.20)years.Group C received RIB under ultrasound guidance before anesthesia induction,and group B and C received intravenous injection with 2 ml of nalbuphine 3 minutes before anesthesia induction,while group A received an equal amount of normal saline intravenously.The intraoperative medication,postoperative recovery,pain,mechanical pain threshold,stress response,immune function,hemodynamics,adverse reactions,and complications were compared among the three groups.One-way ANOVA,repeated measure ANOVA,LSD-t test,and x2 test were used.Results The dosage of propofol,dosage of remifentanil,rescue analgesia rate,and usage rate of vasoactive drugs in group C were lower than those in group A and B,and those in group B were lower than those in group A(all P＜0.05).There were no statistically significant differences in the hospital stay,time of first standing,time of first food intake,or total incidence of complications and adverse reactions among the three groups(all P＞0.05).The mechanical pain thresholds around the incision and inside forearm of the three groups 6 h and 48 h after surgery were lower than those before surgery,and those 48 h after surgery were higher than those 6 h after surgery(all P＜0.05);those in group C were higher than those in group A and B 6 h and 48 h after surgery[(76.25±7.03)g vs.(41.31±5.22)g and(58.06±6.10)g,(81.19±8.24)g vs.(63.44±6.38)g and(76.30±7.21)g,(85.39±7.01)g vs.(72.06±5.23)g and(79.24±6.15)g,(95.07±8.36)g vs.(79.43± 6.28)g and(87.31±7.12)g],those in group B were higher than those in group A 6 h and 48 h after surgery,with statistically significant differences(all P＜0.05).The VAS scores of the three groups 48 h after surgery were lower than those of the same group 1 h and 6 h after surgery,and those 6 h after surgery were lower than those of the same group 1 h after surgery.The VAS scores of group C 1 h,6 h,and 48 h after surgery were lower than those of group A and B,and those of group B were lower than those of group A(all P＜0.05).Twenty-four hours after surgery,the levels of serum cortisol,adrenocorticotropic hormone,and norepinephrine in the three groups were higher than those before surgery,those in group C were lower than group A and B,and those in group B were lower than those in group A(all P＜0.05).Twenty-four hours after surgery,the levels of CD3+and CD4+in the three groups were lower than those before surgery,the levels in group C were higher than those in group A and B,and the levels in group B were higher than those in group A(all P＜0.05).At the end of anesthesia(T2),the heart rate and mean arterial pressure of the three groups were lower than those 5 min after anesthesia induction(T1),but were higher than those 5 min before anesthesia induction(T0),and those of the three groups at T1 were higher than those at T0(all P＜0.05);those of group C were lower than group A and B,and those of group B were lower than those of A group at T1 and T2(all P＜0.05).Conclusion Nalbuphine combined with RIB can inhibit acute hyperalgesia after video-assisted thoracoscopic lobectomy,improve the immune function,reduce the anesthesia drug usage during surgery,alleviate the postoperative pain and stress response,and maintain the hemodynamic stability,which is safe and reliable.
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