The effect of ultrasound-guided thoracic paravertebral nerve block on anesthesia and stress response in middle-aged and elderly patients undergoing radical surgery for lung cancer
Objective To investigate the effect of ultrasound-guided thoracic paravertebral nerve block(TPNB)on anesthesia efficacy and stress response in middle-aged and elderly patients undergoing radical surgery for lung cancer.Methods A total of 104 lung cancer patients who underwent thoracoscopic radical resection for lung cancer at Qingdao Traditional Chinese Medicine Hospital from November 2020 to May 2023 were selected and randomly divided into an observation group(52 cases)and a control group(52 cases)using a random number table method.The observation group received general anesthesia combined with ultrasound-guided TPNB anesthesia during surgery,while the control group received general anesthesia.Two groups of patients were compared in terms of surgical time,intraoperative blood loss,remifentanil and propofol dosage,fluctuation trends of mean arterial pressure(MAP)and heart rate(HR),pain levels in resting and coughing states after surgery,differences in serum stress response indicators[fasting plasma glucose(FPG),cortisol(Cor),norepinephrine(NE),epinephrine(E)]before and after surgery,and adverse reactions.Results There was no statistically significant difference in surgical time,intraoperative blood loss,and single lung ventilation time between the observation group and the control group(all P＞0.05).The usage of remifentanil and propofol in the observation group was lower than that in the control group,and the difference was statistically significant(all P＜0.05).The MAP fluctuation changes at four time points before anesthesia induction,30 minutes during surgery,90 minutes during surgery,and after surgery in the observation group were smaller than those in the control group.Among them,the MAP at 30 minutes during surgery and 90 minutes during surgery was higher than that in the control group(all P＜0.05);There was no statistically significant difference in HR fluctuations between the observation group and the control group at the four time points(all P＞0.05).The Visual Analog Scale(VAS)scores of the observation group patients in resting and coughing states at 12 and 24 hours after surgery were lower than those of the control group at the same time point(all P＜0.05).The serum Cor and E levels in the observation group were lower than those in the control group at 12 hours after surgery,and the serum NE levels were lower than those in the control group at 12 and 24 hours after surgery(all P＜0.05).The incidence of adverse reactions caused by anesthesia in the observation group was lower than that in the control group(P＜0.05).Conclusions The use of ultrasound-guided TPNB combined with general anesthesia in patients undergoing radical surgery for lung cancer is beneficial in reducing intraoperative blood pressure fluctuations,alleviating postoperative pain and stress response,and reducing adverse reactions caused by anesthesia.
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