[Abstract] Objective To investigate the effect of ropivacaine intercostal nerve block the chest tumor patients after thoracotomy analgesia. Methods 80 patients ASA Ⅰ ~ Ⅱ stage thoracotomy were randomly divided into two groups, the experimental group off the chest with the ropivacaine line incision at the nearby thoracic intercostal nerve block anesthesia, the control group did not undergo this treatment. The two groups of patients after intravenous patient-controlled analgesia pump (PCA), postoperative visual pain score (VAS) at different time points was measured, and the record of the first application of PCA, and postoperative 48hPCA effective pressing times and analgesics cumulative usage, and record each group postoperative atelectasis line bronchoscopic suctioning trips. Results the Ropivacaine intercostal block can greatly reduce the pain after thoracotomy wound to reduce the amount of postoperative analgesic atelectasis occurred. Conclusion ropivacaine intercostal nerve block is easy to use, the analgesic effect, can be used as a the conventional thoracotomy postoperative analgesic.
Key words ropivacaine ropivacaine thoracic surgery nerve block
After thoracotomy pain is one of the most serious post-operative pain, postoperative pain not only bring physical and psychological discomfort to the patient and lead to serious pulmonary complications or chronic pain caused by breathing, coughing or movement of the poor after thoracotomy pain syndromes, especially chest tumor patients are often older, cardiopulmonary complications, pain greater the negative impact of postoperative. Thus, thoracic surgery and select appropriate postoperative analgesic measures is very important, Ropivacaine is a new long-term L-amide local anesthetic, low toxic, long duration of action, while low concentration ropivacaine Cain has analgesic effects obvious but no obvious motor nerve block characteristics , the theory is very suitable for the higher requirements of breath and cough after thoracotomy analgesia. The purpose of this study is to observe the clinical effect of ropivacaine intercostal nerve block.
1 Materials and Methods
1.1 The object of study
Selected according to the American Society of Anesthesiologists (ASA) grade Ⅰ ~ Ⅱ, aged 35 to 65 years of age, elective thoracic surgery 80 patients. Preoperative severe heart disease, severe pulmonary dysfunction, severe liver and kidney dysfunction, mental disorders and long-term use of narcotic analgesics history except 55 males and 25 females, were randomly divided into two groups, Ⅰ group was the experimental group, including 21 cases of the lung, and esophageal cancer 19 cases. Ⅱ group, the control group, 20 cases in which lung cancer and esophageal cancer.
Patients preoperative of 30min intramuscular stability (Amino Acid Co., Ltd., Tianjin Jinyao H12020957) 0.15mg/kg atropine (Amino Acid Co., Ltd., Tianjin Jinyao H12020382) 0.01mg/kg into the operating room, monitoring tidal volume, respiratory rate, heart rate blood pressure, electrocardiogram and blood oxygen saturation, the establishment of a peripheral or central venous access, conventional intravenous atropine 0.5mg or scopolamine (Xuzhou Ryan, Pharmaceutical Limited H32022136) 0.3mg, induced with fentanyl (Yichang Humanwell Pharmaceutical limited liability company) 4μg/mg midazolam (Jiangsu En China Pharmaceutical Group Co., Ltd. H19990027) 0.1mg/kg, vecuronium (Organon, the Netherlands Batch No.: 223 093) 0.12mg/kg, propofol (Italy Astrazereca SPA EC239) 0.6mg/kg, inserted double-lumen endobronchial underwent mechanical ventilation in the correct position, the inhalation of 0.8% to 2% isoflurane (Baxter the medical supplies Trade Co., Ltd. N053G705A), intraoperative intermittent injection of vecuronium to maintain The depth of anesthesia. Group Ⅰ patients off the chest by a surgeon to 0.375% ropivacaine (LoT HK 1539) 20ml along the incision and thoracic intercostal nerve bundle under three intercostal space near the needle of the 6th line blood vessels and nerves beam the intrathecal puncture injections, of Ⅱ group of patients had no this operation. The two groups of patients to be the end of surgery, the recovery of spontaneous breathing, extubation placed vein the PCA pain pump with liquid: 40mg morphine (Shenyang Pharmaceutical Factory 070405) plus 36ml saline.
1.3 postoperative monitoring
Patients preoperative, postoperative follow-up by hand, to the patients and their families about the VAS score PCA use and explain the importance of cough, expectoration and the right way. Surgery patients can correctly answer the simple instructions action (after 0h) were observed and recorded postoperative 4h, 8h, 24h, 48h the VAS score, score 0-10 points. 0 painless, 10, said the most severe pain possible. Time record for the first time requires the use of PCA and 48h after total PCA effective pressing times and the pain pump analgesics cumulative amount of bronchoscopic suctioning recorded at the same time the two groups of patients within 48h poor because of cough caused atelectasis be the passengers.
1.4 statistical methods
Measurement data were expressed as mean ± standard deviation (± s), analyzed using SPSS statistical software. Measurement data were compared using analysis of variance, count data was used to compare the χ2 test, P <0.05, the difference was statistically significant.
Comparison of the two groups of patients in the total postoperative 4h, 8h, 24h, 48h VAS score, 48h after PCA effective pressing times and analgesics accumulated amount, the the ropivacaine intercostal nerve block group were significantly lower than control group, and ropivacaine intercostal nerve block group for the first time using the PCA time later, required bronchoscopic suctioning trips accordingly less significant difference between the two groups, as shown in Table 1 and 2. Table VAS scores of the two groups of patients with postoperative time point
Thoracic tumor patients are often older, cardiopulmonary complications more and the postoperative need frequent cough, sputum production in order to reduce the incidence of pulmonary complications after thoracotomy analgesia is very important, and helps to reduce pain in patients, so that patients get better rest, while thoracic natural movement without affecting the case, cough, expectoration, conducive to benefit the patient postoperative recovery, and reduce the incidence of complications. Thoracic Surgery postoperative analgesic method include: (1) systemic analgesia; (2) epidural analgesia; (3) the pleural cavity administration; intercostal nerve block; the pleura block or paravertebral block; (4) patient-controlled administration of analgesia (PCA); (5) transcutaneous electrical nerve stimulation (TENS); (6) cryotherapy . Ropivacaine amide local anesthetic, pharmacological studies table demonstrates the ropivacaine block C fibers faster than A fibers and has a frequency-dependent, and bupivacaine compared to similar concentrations of ropivacaine A fiber The blockade lighter, while the degree of blocking both C fibers similar to . Ropivacaine this separation blockade makes it lighter than a considerable concentration of bupivacaine on motor nerve block for analgesia local anesthetic after thoracotomy analgesia ropivacaine cocaine and more widely, ropivacaine epidural analgesia after thoracotomy [4,5] or continuous paravertebral nerve block  can achieve good analgesic effect. The study found that by the postoperative intercostal nerve block ropivacaine patients after the 48h period pain intensity was significantly reduced compared with the control group, used for the first time after the PCA late to remedy the analgesia morphine also decreased significantly, and the experimental group patients rest and physical recovery the better plus intercostal motor nerve to a lesser extent by the block, these are conducive to the postoperative respiratory motion and cough, expectoration, makes and reduce the rate of atelectasis. Intercostal nerve block with ropivacaine epidural analgesia or continuous paravertebral nerve block achieved good analgesic effect, but Ropivacaine intercostal nerve block surgery is done under direct vision, rib interosseous nerve revealed clear, a one-time operation is completed and the state of anesthesia, minimal damage to the surrounding tissue. Epidural analgesia with ropivacaine or continuous paravertebral nerve block compared to its ease of operation, simple and avoid the complications of epidural analgesia, such as: the dural perforation; catheter placed improper ; postoperative nerve root pain; reactive catheter exit and peripheral nerve injury.
In summary, the chest tumor surgery patients through off chest ropivacaine intercostal nerve block can reduce post-operative pain, reduce postoperative analgesic requirements, and helps to reduce pulmonary complications, and has under direct vision is easy to operate and simple, the analgesic effect is obvious, time-saving and other advantages, and one-time administration of drug dependence and addiction, worthy of promotion.