Effect of thoracic paravertebral block on perioperative analgesia in patients undergoing off-pump coronary artery bypass grafting surgery
Objective To investigate the efficacy and safety of thoracic paravertebral block(TPVB)as an adjuvant analgesic method in patients undergoing off-pump coronary artery bypass grafting(CABG).Methods Patients scheduled for elective off-pump CAGB at the First Affiliated Hospital of Nanjing Medical University from March 2022 to September 2023 were enrolled and randomly assigned to the TPVB group(observation group)or the traditional anesthesia group(control group)using a random number table.Patients in the observation group received ultrasound-guided bilateral TPVB before surgery,while those in the control group received no special preoperative treatment.The analgesic effect,recovery,and safety were compared between the two groups.Results A total of 60 patients were included,30 cases in the observation group and 30 cases in the control group.The static and dynamic visual analogue scale(VAS)scores were lower in the observation group than that in the control group at 24 and 48 hours postoperatively(P<0.05),but there was no significant difference between the two groups at 72 hours postoperatively(P>0.05).The time to first patient-controlled analgesia(PCA)press was significantly delayed in the observation group[(5.1±1.2)h]compared to the control group[(2.0±0.9)h],and the number of PCA presses was lower in the observation group at 24 and 48 hours postoperatively[2(1,4)number of times vs 4(3,5)number of times,5(3,7)number of times vs 7(5,9)number of times,P<0.01].However,there was no significant difference in PCA presses between the two groups at 72 hours postoperatively(P>0.05).Patients in the observation group had lower intraoperative remifentanil consumption and fewer postoperative rescue analgesic administrations[1.0(0.5,1.6)mg vs 2.2(1.8,2.5)mg,1(0,1)number of times vs 3(2,3)number of times,respectively],as well as shorter postoperative extubation time and ICU stay[(5.4±2.5)h vs(7.0±2.9)h,(10.8±3.2)h vs(13.7±3.9)h],with statistically significant differences(P<0.05).However,there was no significant difference in postoperative hospital stay between the two groups(P>0.05).The incidence of nausea and vomiting within 72 hours postoperatively was lower in the observation group(20.0%vs 50.0%,10.0%vs 36.7%),with statistically significant differences(P<0.05).Conclusion The application of TPVB can improve some early postoperative analgesic outcome measures in patients undergoing off-pump CABG,reduce the dose of analgesic medications,and demonstrate good safety.
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