Effect of thoracic paravertebral block combined with general anesthesia in radical operation of elderly patients with lung cancer

Objective To observe the analgesic effect of thoracic paravertebral block (TPVB) combined with general anesthesia in radical operation of elderly lung cancer, and its influence on adrenal cortex function and cognitive function.

Methods Seventy elderly patients who underwent radical operation of lung cancer were randomly divided into control group (general anesthesia, n=35) and observation group (TPVB combined with general anesthesia, n=35). Operation conditions, heart rate (HR), mean arterial pressure (MAP), adrenocortical functions cortisol (Cor), adrenocorticotropic hormone (ACTH), aldosterone (ALD), and cognitive functions central nervous system specific protein (S100β), brain-derived neurotrophic factor (BDNF), and mini-mental state examination (MMSE) score were observed and compared.

Results The intraoperative dosage of remifentanil and the compression times of patient-controlled intravenous analgesia (PCIA) were lower, and the length of post-anesthesia care unit (PACU) stay in the observation group was shorter than those in control group (P < 0.05). HR and MAP in the observation group were lower than those in the control group at 5 min of operation and at conclusion of operation, the differences were statistically significant (P < 0.05). At 24 h after surgery, the levels of Cor, ACTH and ALD were (319.03±44.41) μg/L, (12.05±1.64) pmol/L and (119.00±20.68) ng/L, respectively, which were lower than (341.36±39.49) μg/L, (15.84±2.21) pmol/L and (186.88±22.03) ng/L compared with the control group (P < 0.05). At 24 h after surgery, the level of S100β in the observation group was (96.94±15.51) ng/L, which was lower than (112.01±15.76) ng/L in the control group (P < 0.05). At 24 h after surgery, BDNF level and MMSE score in the observation group were (25.93±3.71) ng/mL and (25.34±1.63), respectively, which were higher than (23.43±4.60) ng/mL and (23.86±2.09) in the control group (P < 0.05).

Conclusion TPVB combined with general anesthesia can achieve better analgesic effect in radical operation of elderly lung cancer. It is conducive to intraoperative hemodynamic stability and recovery from anesthesia, and can relieve the influence on adrenal cortex function and cognitive function.