关键词: 胸椎旁神经阻滞；肋间神经阻滞；腔镜下肺叶切除术；麻醉药用量；镇痛效果

Abstract: Objective To explore the effects of ultrasound-guided intercostal nerve block(INB) and thoracic paravertebral nerve block(TPVB) on the dosage of anesthetics and the efficacy of analgesia in video-assisted thoracoscopic lobectomy.Methods From October 2019 to October 2023,90 patients undergoing video-assisted thoracoscopic lobectomy at the People's Hospital of Tongling City,Anhui,were selected.They were divided into the INB group(42 cases) and the TPVB group(48 cases).The INB group received ultrasound-guided intercostal nerve block,while the TPVB group was administered ultrasound-guided thoracic paravertebral nerve block.The two groups were compared before anesthesia induction (T0), 15 minutes of anesthesia (T1), 30 minutes of anesthesia (T2), 45 minutes of anesthesia (T3), and after extubation (T4), vital signs, anesthetic dosage, analgesic effect, pain stress index and adverse reactions.Results In the TPVB group,systolic blood pressure (SBP) of T1, T2, T3 and T4 were (115.88±9.29) mmHg, (113.58±9.72) mmHg, (117.33±9.17) mmHg and (121.15±10.51) mmHg, respectively;diastolic blood pressure (DBP) were (86.74±7.35) mmHg, (90.83±8.82) mmHg, (90.83±8.82) mmHg and (91.05±8.73) mmHg, respectively;Heart rate (HR) were (79.94± 7.46)times/min, (81.97±7.28)times/min, (82.36±7.41)times/min and (85.83±8.32) times/min, respectively.Which were all higher than the INB group[ (103.53±8.28) mmHg, (105.40±8.66) mmHg, (109.03±8.13) mmHg, (114.64±9.65) mmHg. (77.68±6.57) mmHg, (79.27±6.69) mmHg, (83.21±7.37) mmHg, (85.83±8.21) mmHg, (71.17±6.21) times/min, (75.18±6.47) times/min, (74.82±6.12) times/min and (79.35±7.12) times/min,respectively], there were statistical significance between the two groups (P<0.05).Postoperatively,the TPVB group had lower 24-hour sufentanil consumption[(27.68±2.64) μg] and fewer presses of the analgesia pump[(5.16±0.38) times] compared to the INB group[(36.22±3.36) μg and (6.87±0.42) times,(P<0.05)].Visual analogue scale(VAS) scores for pain at rest and during coughing at 2,24,and 48 hours in group TPVB were 2.44±0.27,3.55±0.42,2.81±0.34 and 3.36±0.23,4.13±0.33,3.80±0.25,respectively,which were also lower than the INB group(2.83±0.44,3.98±0.55,3.33±0.46 and 3.87±0.30,4.59±0.47,4.17±0.29,respectively)(P<0.05).Levels of prostaglandin E2(PGE2)(1.53±0.28 μg/L),norepinephrine(NE)(362.25±33.85 ng/L),and cortisol(Cor)(278.72±25.13 ng/L) in the TPVB group were lower than those in the INB group(2.71±0.32 μg/L,425.67±38.37 ng/L,315.68±29.21 ng/L)(P<0.05).Adverse reactions such as nausea and vomiting,and dizziness were less frequent in the TPVB group [1(2.1%),1(2.1%)] compared to the INB group [6(12.5%),5(10.4%)](P<0.05).Conclusion Ultrasound-guided thoracic paravertebral nerve block is superior to intercostal nerve block in terms of anesthetic dosage and analgesic efficacy in video-assisted thoracoscopic lobectomy.

Key words: thoracic paravertebral nerve block;intercostal nerve block;video-assisted thoracoscopic lobectomy;anesthetic dosage;analgesic effect