Effects of Thoracic Paravertebral Block on Nociceptive Levels After Skin Incision During Video-Assisted Thoracoscopic Surgery
Effects of Thoracic Paravertebral Block on Nociceptive Levels After Skin Incision During Video-Assisted Thoracoscopic Surgery
复制标题
DOI：
10.12659/msm.914354
复制
发表时间：
2019-04-28
影响因子：
3.1
通讯作者：
Hirose, Munetaka
中科院分区：
文献类型：
--
作者：
Miyawaki, Hiroki;Ogata, Hiroki;Hirose, Munetaka
背景：区域麻醉具有良好的术后镇痛效果。然而，在全身麻醉下的手术中，区域麻醉对伤害性水平的影响还没有被定量评估。为了揭示胸椎旁阻滞(PVB)对全身麻醉下皮肤切开后伤害性感觉水平的影响，我们对无严重术前条件或合并并发症的患者进行了一项回顾性队列研究，这些患者接受了择期电视胸腔镜手术(VATS)。使用我们先前确定的伤害性反应(NR)方程，利用常见的血流动力学参数来计算全身麻醉期间的伤害性水平。材料/方法：从我们的机构数据库中回顾地获得了从2018年5月至2018年8月77例成人患者的VATS数据。然后，我们对接受胸部PVB的患者(PVB组：n=29)和没有接受PVB的患者(对照组：n=48)进行倾向评分匹配。计算切皮前(T0)、切皮后5~10min(T1)、切皮后10~15min(T2)、切皮后15~20min(T3)、切皮后20~25min(T4)的平均收缩压(SBP)、心率(HR)、血流灌注指数(PI)、脑电双频指数(BIS)、NR值。PVB组T1、T2时平均NR值显著低于对照组。两组间SBP、HR、PI、BIS除T2时SBP外，其余指标均无显著差异。结论：胸腔PVB可预防VATS患者胸腔静脉麻醉后NR值的升高。
Background: Regional anesthesia provides excellent analgesic effects after surgery. However, the effects of regional anesthesia on nociceptive levels during surgery under general anesthesia have not been quantitatively evaluated. To reveal the effects of thoracic paravertebral block (PVB) on nociceptive levels after skin incision during general anesthesia, we performed a retrospective cohort study in patients without serious preoperative conditions or comorbidities undergoing elective video-assisted thoracoscopic surgery (VATS). Nociceptive levels during general anesthesia were calculated using our previously determined Nociceptive Response (NR) equation, which utilizes common hemodynamic parameters.Material/Methods: Data on 77 adult patients who underwent VATS from May 2018 to August 2018 were retrospectively obtained from our institutional database. We then performed propensity score matching between patients who received thoracic PVB (PVB group: n=29) and those who did not (Control group: n=48). The averaged values of systolic blood pressure (SBP), heart rate (HR), perfusion index (PI), bispectral index (BIS), and NR from 10 to 5 minutes before skin incision (T0), 5 to 10 minutes (T1), 10 to 15 minutes (T2), 15 to 20 minutes (T3), and 20 to 25 minutes after skin incision (T4), were calculated.Results: Twenty-four propensity score-matched patients in each group were analyzed. Mean NR values at T1 and T2 in the PVB group were significantly lower than those in the Control group. SBP, HR, PI, and BIS, however, showed no significant differences between the 2 groups, except for SBP at T2.Conclusions: Thoracic PVB prevented an increase in NR values, which quantitatively represent nociceptive levels under general anesthesia, in patients undergoing VATS.