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| Application effect of different concentrations of Ropivacaine ultrasoundguided erector spinal muscle plane block in perioperative period of thoracoscopic surgery |
| MEI Chao LU Ze'an |
| Department of Anesthesiology, Huizhou First People's Hospital, Guangdong Province, Huizhou 516000, China |
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Abstract Objective To investigate the effect of ultrasound-guided erector spinal muscle plane block (ESPB) with different concentrations of Ropivacaine on immune inflammation, pain and lung function after thoracoscopic lobectomy. Methods From January 2020 to March 2021, 120 patients who were scheduled to undergo thoracoscopic lobectomy in Huizhou First People's Hospital were selected as the research objects. The patients were divided into group A (n=30), group B (n=30), group C (n=30) and group D (n=30) by random number table method. Group D received patientcontrolled intravenous analgesia (PCIA) alone, On the basis of group D, group A, group B and group C received ESPB analgesia at the left T5level with 0.250%, 0.375% and 0.500% Ropivacaine under ultrasound guidance, respectively. Forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and Prince-Henry pain score were measured before operation (T0), on the first day after operation (T1), and after thoracic drainage tube removal (T2) of four groups. Venous blood was collected to detect the levels of T lymphocyte subsets, C-reactive protein (CRP), tumor necrosis factor α(TNF-α) and other immune inflammatory indicators. The total incidence of adverse reactions and the number of remedial analgesia were statistically compared among the four groups. Results At T1and T2, Prince-Henry pain scores in group A, group B and group C were lower than those in group D, with statistically significant differences （P＜0.05）. There were no significant differences in FEV1and FVC among the four groups at T0 (P＞0.05). At T1and T2,FEV1and FVC of the four groups were lower than T0, with statistical significance（P＜0.05）. At T1and T2, FEV1and FVC in group A, B and C were higher than those in group D, and FEV1and FVC in group B and C were higher than those in group A, with statistical significance（P＜0.05）. At T0, there was no significant difference in immune inflammation indexes among the four groups (P＞0.05). At T1 and T2, the immune inflammatory indexes of the four groups were lower than T0, with statistical significance (P＜0.05). At T1and T2, CD8+, CRP and TNF-α in group A, B and C were lower than those in group D, and CD3+and CD4+were higher than those in group D, CD8+, CRP and TNF-α in group B and C were lower than those in group A, while CD3+and CD4+were higher than those in group A, with statistical significance (P＜0.05). The number of remedial analgesia in group A, B and C was lower than that in group D, and the number of remedial analgesia in group B and C was lower than that in group A, with statistical significances （P＜0.05）. There was no significant difference in the number of remedial analgesia between group B and group C (P＞0.05). There was no significant difference in the total incidence of adverse reactions among the four groups (P＞0.05). Conclusion Ropivacaine ultrasound-guided ESPB after thoracoscopic lobectomy has a better analgesic effect and helps to improve immune inflammation and pulmonary function. And the application of ropivaca at a concentration of 0.375% is more feasible and safe.
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