Effect of paravertebral nerve block on intraoperative blood flow，postoperative stress and rehabilitation quality of obese patients undergoing minimally invasive gastrectomy

doi:10.3877/cma.j.issn.2095-2015.2024.06.017

Abstract

Abstract:

Objective

To analyze the influence of paravertebral nerve block on blood flow，postoperative stress and rehabilitation quality of obese patients undergoing minimally invasive gastrectomy.

Methods

One hundred and twenty-six obese patients undergoing minimally invasive gastrectomy in Peking University First Hospital Taiyuan Hospital from January 2022 to December 2023 were selected and randomly divided into observation group （n=63） and control group （n=63）. The control group was anesthetized with epidural block，while the observation group was anesthetized with paravertebral nerve block. Both groups of operations were completed by the cooperation of the same medical team and anesthesia team. The operation and recovery，intraoperative hemodynamic changes，postoperative stress indexes and postoperative complication rate were compared between the two groups.

Results

The time of getting out of bed for the first time in the observation group was shorter than that in the control group （P＜0.05）. At the beginning of operation，30 min，60 min and after operation，MAP and HR in the observation group were lower than those in the control group （P＜0.05）. Epinephrine （E） and norepinephrine （NE） in the observation group were higher than those in the control group after operation，and dopamine was lower than that in the control group. E，NE and dopamine in the observation group were lower than those in the control group at 24 h after operation （P＜0.05）. The numeric rating scale （NRS）scores in the observation group were lower than those in the control group at 2 h，6 h，12 h and 24 h afteroperation （P＜0.05）. No complications such as abdominal infection，hematoma and nerve injury occurred in both groups after operation.

Conclusion

Compared with epidural block，paravertebral nerve block anesthesia can maintain the stability of blood flow and postoperative stress indexes in obese patients during minimally invasive gastrectomy，which is beneficial to relieve postoperative pain and improve the quality of rehabilitation.

Key words: Gastrectomy, Paravertebral nerve block, Laparoscope, Obesity, Hemodynamics, Stress, Rehabilitation quality

Haowen Xie, Jianying Ding, Xiaoxia Liu, Yi Feng, Jing Yao. Effect of paravertebral nerve block on intraoperative blood flow，postoperative stress and rehabilitation quality of obese patients undergoing minimally invasive gastrectomy[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(06): 569-573.

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URL: https://zhxhbyyxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-2015.2024.06.017

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Figures/Tables 6

组别	例数	年龄（岁， $\bar{x}$ ±s）	体重指数（kg/m²， $\bar{x}$ ±s）	肥胖病程（年， $\bar{x}$ ±s）	性别[例（%）]		ASA分级[例（%）]
组别	例数	年龄（岁， $\bar{x}$ ±s）	体重指数（kg/m²， $\bar{x}$ ±s）	肥胖病程（年， $\bar{x}$ ±s）	男	女	Ⅱ级	Ⅲ级
观察组	63	34.89±4.02	37.08±2.19	13.29±3.08	21（33.33）	42（66.67）	58（92.06）	5（7.94）
对照组	63	35.13±3.97	37.33±2.05	13.17±2.75	24（38.10）	39（61.90）	55（87.30）	8（12.70）
t/χ²值		0.337	0.661	0.231	0.311		0.772
P值		0.737	0.510	0.818	0.578		0.380

组别	例数	年龄（岁， $\bar{x}$ ±s）	体重指数（kg/m²， $\bar{x}$ ±s）	肥胖病程（年， $\bar{x}$ ±s）	性别[例（%）]		ASA分级[例（%）]
组别	例数	年龄（岁， $\bar{x}$ ±s）	体重指数（kg/m²， $\bar{x}$ ±s）	肥胖病程（年， $\bar{x}$ ±s）	男	女	Ⅱ级	Ⅲ级
观察组	63	34.89±4.02	37.08±2.19	13.29±3.08	21（33.33）	42（66.67）	58（92.06）	5（7.94）
对照组	63	35.13±3.97	37.33±2.05	13.17±2.75	24（38.10）	39（61.90）	55（87.30）	8（12.70）
t/χ²值		0.337	0.661	0.231	0.311		0.772
P值		0.737	0.510	0.818	0.578		0.380

组别	例数	手术时间（min）	术中出血量（mL）	术后住院时间（d）
观察组	63	132.58±26.95	18.91±4.26	3.91±0.78
对照组	63	130.47±28.81	18.76±4.11	3.83±0.89
t值		0.425	0.201	0.537
P值		0.672	0.841	0.593

组别	例数	首次下床活动时间（h）	肛门排气时间（h）	首次饮水时间（d）	首次进食时间（d）
观察组	63	15.62±3.87	21.25±5.18	0.97±0.11	1.99±0.26
对照组	63	24.26±4.99	22.06±5.34	1.01±0.13	2.05±0.31
t值		10.860	0.864	1.864	1.177
P值		＜0.001	0.389	0.065	0.241

组别	例数	时间	平均动脉压（mmHg）	心率（次/min）
观察组	63	麻醉前	89.35±5.59	70.71±6.87
		手术开始时	71.06±8.87^*	65.33±8.02^*
		手术30 min	72.91±6.05^*	65.26±7.19^*
		手术60 min	77.26±7.14^*	64.33±7.02^*
		术毕	78.47±7.19^*	63.61±9.08^*
对照组	63	麻醉前	90.13±7.22	71.19±9.47
		手术开始时	84.37±7.89^*#	69.38±6.82^*#
		手术30 min	82.97±8.03^*#	67.94±7.15^*#
		手术60 min	83.15±9.79^*#	68.13±7.26^*#
		术毕	80.83±10.26^*#	65.99±6.62^*#

组别	例数	时间	肾上腺素	去甲肾上腺素	多巴胺
观察组	63	麻醉前	168.83±23.57	192.04±18.63	35.38±6.69
		术毕	81.66±5.79^*	152.57±16.41^*	62.13±7.19^*
		术后24 h	182.39±19.81^*	313.89±41.67^*	50.53±5.92^*
对照组	63	麻醉前	169.41±22.96	191.59±17.44	35.41±6.24
		术毕	76.75±5.28^*#	130.31±12.59^*#	70.75±7.47^*#
		术后24 h	207.79±18.95^*#	461.48±43.49^*#	55.38±6.04^*#

组别	例数	术后2 h	术后6 h	术后12 h	术后24 h
观察组	63	2.38±0.31	1.80±0.25^*	1.62±0.19^*	1.23±0.16^*
对照组	63	3.47±0.52	3.11±0.43^*	2.61±0.26^*	1.46±0.19^*
t值		14.291	20.905	24.401	7.349
P值		＜0.001	＜0.001	＜0.001	＜0.001

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