Effects of thoracic paravertebral nerve block on hemodynamics during induction of anesthesia and postoperative recovery in patients undergoing coronary artery bypass grafting

Abstract

Objective To investigate the effects of thoracic paravertebral nerve block (TPVB) on hemodynamics during induction of anesthesia and postoperative recovery in patients undergoing coronary artery bypass grafting (CABG).

Methods Fifty patients were selected for elective CABG at the First Affiliated Hospital of Bengbu Medical College from August 2020 to August 2021. The patients were divided into two groups using the random number table method : TPVB combined with general anesthesia group (group P) and conventional general anesthesia group (group G), each group contained 25 patients. The mean arterial pressure (MAP) and heart rate (HR) before induction of anesthesia (T0), before tracheal intubation (Tl), immediately after tracheal intubation (T2), 1 min (T3) and 5 min (T4) after tracheal intubation, intraoperative sufentanil dosage, postoperative mechanical ventilation time, the visual analogue scale (VAS) scores after extubation, 12 and 24 h postoperatively, 24 h postoperative remedial analgesia cases, length of stay in the cardiac surgical intensive care unit (CSICU), postoperative hospital stay, and postoperative adverse effects were all recorded and analyzed accordingly.

Results MAP at T2–T4 in group P were (74.84± 10.05) mm Hg (1 mm Hg = 0.133 kPa), (74.96±10.03) mm Hg, (74.72±9.18) mm Hg, which were lower than those of group G [(85.08±10.57) mm Hg, (89.16±10.00) mm Hg, (81.04±8.92) mm Hg, all P<0.05]; HR at T2–T4 in group P were lower than those in group G (all P<0.05). Intraoperative sufentanil dosage, postoperative mechanical ventilation time, and length of stay in the CSICU in the group P were less than those in group G (all P<0.05). The VAS scores at all postoperative time points in the group P were lower than those in the group G (all P<0.05). The number of cases of remedial analgesia at 24 h postoperatively in the group P was less than that in the group G ( P<0.05). There was no statistically significant difference in the incidence of nausea and vomiting and pulmonary infection between the two groups (all P>0.05).

Conclusion TPVB can maintain stable hemodynamics during the induction period of anesthesia in patients undergoing coronary artery bypass grafting. It also alleviates postoperative pain, reduces the amount of analgesic drugs, and facilitates the early postoperative recovery of patients.

Abstract

摘要：目的 探讨胸椎旁神经阻滞对冠脉搭桥术患者麻醉诱导期血流动力学及术后恢复的影响。 方法 选择 2020年8月一2021年8月于蚌埠医学院第一附属医院择期行冠脉搭桥手术的患者50例。根据随机数字表法将 患者分为胸椎旁神经阻滞联合全麻组( P组)和常规全麻组(G组)，每组25例。记录2组患者麻醉诱导前(T0)、插管前(T1)、插管即刻(T2)、插管后1 min (T3)及5 min (T4)的平均动脉压(MAP)和心率(HR);术中舒芬太尼用 量;术后机械通气时间;拔管后、术后12、24 h的VAS评分;术后24 h补救镇痛例数;留置心脏外科重症监护室时 间、术后住院时间；术后不良反应。 结果 P组T2~T4时点的MAP分别为(74.84±10.05)mm Hg (1 mm Hg = 0.133 kPa)、(74.96±10.03)mm Hg、(74.72±9.18)mm Hg, 均低于 G 组[(85.08±10.57) mm Hg、(89.16±10.00) mm Hg、(81.04±8.92)mm Hg, 均 P<0.05]; P 组 T2~T4 时点的HR均低于G组(均 P<0.05)。P组术中舒芬太尼 用量、术后机械通气时间、留置心脏外科重症监护室时间均少于G组(均 P<0.05); P组术后各时间点的VAS评 分均低于G组(均 P<0.05);P组术后24 h补救镇痛例数少于G组( P<0.05); 2组恶心呕吐、肺部感染的发生率 比较差异无统计学意义(均 P>0.05)。 结论 胸椎旁神经阻滞可维持冠脉搭桥术患者麻醉诱导期血流动力学平 稳, 减轻术后疼痛, 减少镇痛药物用量, 有利于患者术后早期恢复。