Thoracic Paravertebral Block Combined with General Anaesthesia or General Anaesthesia Alone for Thoracoscopic Lung Adenocarcinoma Surgery: A Retrospective Study

Abstract

Purpose: To investigate the effects of ultrasound-guided thoracic paravertebral block combined with general anaesthesia or general anaesthesia alone for thoracoscopic lung adenocarcinoma surgery, and to provide new thoughts for improving the clinical outcomes.

Methods: This was a retrospective study. Data were retrieved for 195 patients with lung adenocarcinoma undergoing elective radical lobectomy via video-assisted thoracoscopy between January 2018 and August 2019 in The Second Hospital of Shandong University, including 86 patients who received thoracic paravertebral block (TPVB) combined with general anaesthesia (group TG), and 109 patients who received general anaesthesia alone (group GA). All patients were given self-controlled intravenous analgesia pump for 48 h after surgery. The primary outcome was the recurrence-free survival 2 years postoperatively (the time between surgery and the earliest date of recurrence, metastasis or lung cancer-cause death). The secondary outcomes included the average numeric rating scale (NRS) scores within 48 h postoperatively, the first time of postoperative ambulation, duration of chest tube drainage, length of postoperative hospitalization, perioperative opioid consumption and the postoperative side effects.

Results: There were no statistical differences in the recurrence-free survival 2 years postoperatively between groups (Multivariate hazard ratio 0.706, 95% CI 0.126-3.941, P=0.691). The average NRS scores within 48 h postoperatively were significantly lower in group TG (P<0.05). The first time of postoperative ambulation, duration of chest tube drainage, and length of postoperative hospitalization in group TG were significantly reduced (P<0.05). Opioid consumption was significantly decreased in group TG (P<0.01). Finally, the incidence of postoperative nausea and vomiting (PONV) was significantly lower in group TG (P<0.05).

Conclusion: TPVB for thoracoscopic lung adenocarcinoma surgery did not improve the recurrence-free survival 2 years postoperatively compared with general anaesthesia alone, but it significantly enhanced the postoperative analgesia effect, reduced opioid consumption as well as side effects, and accelerated postoperative early recovery.

Clinical trial registration number: The Chinese Clinical Trial Registry (ChiCTR-2100050454).

Keywords: lung adenocarcinoma; prognosis; thoracic paravertebral block; ultrasound guidance; video-assisted thoracoscopic surgery.

Figure 1

Ultrasound image of the thoracic paravertebral block. The red arrow denotes the puncture path of the needle. Compared with the picture above, the pleura in the picture below is being pressed down by the local anaesthetics.

Figure 2

Flow diagram of the study.

Figure 3

Comparison of Kaplan–Meier survival curves for the 2-year postoperative recurrence-free survival between groups. There were no statistical differences in the 2-year postoperative recurrence-free survival between groups (multivariate hazard ratio 0.706, 95% CI 0.126–3.941, P=0.691).

Figure 4

Comparison of the average pain scores 48 h postoperatively between groups. The data are given as mean ± SD, compared with group GA, *P<0.05. Data were compared by independent-sample t-test.

Figure 5

Comparison of postoperative early recovery between groups. The first time of postoperative ambulation (A), the duration of chest tube drainage (B), the length of postoperative hospitalization (C). The data are given as mean ± SD, compared with group GA, *P<0.05. Data were compared by independent-sample t-test.

Figure 6

Comparison of intraoperative and postoperative sufentanil dosage between groups. The data are given as mean ± SD, compared with group GA, *P<0.01. Data were compared by independent-sample t-test.