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The Efficacy and Safety of Paravertebral Block Combined with Parecoxib During Video-Assisted Thoracic Surgery: A Randomized Controlled Trial

Authors Yang J, Hao Z, Li W, Duan C, Fan X, Xin J, Ren C

Received 4 January 2020

Accepted for publication 29 January 2020

Published 11 February 2020 Volume 2020:13 Pages 355—366

DOI https://doi.org/10.2147/JPR.S244787

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Michael Schatman


Junling Yang,1 Zaijun Hao,1 Wei Li,1 Caiping Duan,1 Xiujuan Fan,1 Jing Xin,1 Chunguang Ren2

1Department of Anesthesiology, Ordos Central Hospital, Ordos, People’s Republic of China; 2Department of Anesthesiology, Liaocheng People’s Hospital, Liaocheng, Shandong, People’s Republic of China

Correspondence: Chunguang Ren Email weiyichunguang@163.com

Background: Although video-assisted thoracoscopic surgery (VATS) is increasingly used, the optimal analgesia strategy is still unknown. We explore the efficacy and safety of preemptive ultrasound-guided paravertebral block (PVB) combined with parecoxib during VATS.
Methods: Seventy-four patients were divided into two groups. PVBs were performed before anesthesia induction under real-time ultrasound guidance. Visual analog scale (VAS) score with coughing at 48 h after surgery, postoperative sufentanil consumption and level of sedation (LOS) at 1, 4, 8, 12, 24, and 48 h postoperatively, intraoperative hemodynamics, satisfaction scores of patients and surgeons, remedial measures, time to chest tube removed and mobilization, adverse effects and hospital stay length were recorded. We also recorded inflammatory markers, respiratory function and the prevalence of chronic pain after surgery.
Results: VAS scores at rest and with coughing during the first 24 h after surgery were significantly lower in the P group (P< 0.05). Consumption of sevoflurane, remifentanil, and dexmedetomidine was all significantly reduced in the P group (P< 0.05). The consumption of sufentanil within 48 h after surgery, time to first dose and total dose of rescue ketorolac was significantly lower in the P group (P< 0.05). The FEV1/FVC ratio was significantly higher in the P group at 1 and 3 d after surgery (P< 0.05). Times to chest tube removal and mobilization were significantly shorter in the P group (P< 0.05). Compared with the C group, the level of both ACTH and cortisol was significantly reduced in the P group at 1 and 3 d after surgery (P< 0.05).
Conclusion: PVB combined with parecoxib was associated with better pain relief, decreased sufentanil and ketorolac consumption, less hemodynamic instability, and a lower surgery-related stress response. However, the incidences of chronic pain 3 and 6 months after surgery and the risk of complication except urinary retention were not significantly different between groups.

Keywords: paravertebral block, parecoxib, video-assisted thoracic surgery, preemptive analgesia


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