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.

BackgroundUltrasound guided-deep serratus anterior plane block (USG-DSAPB) has been used for pain management of patients undergoing modified radical mastectomy (MRM), but evidence supporting their adjuvant analgesic benefits is limited. We explored the efficacy and safety of preemptive use of ropivacaine combined with different doses of dexmedetomidine (DEX) in USG-DSAPB for patients undergoing MRM.MethodsNinety-five female patients undergoing unilateral MRM were allocated randomly to two groups. Group RD1 had 20 mL of 0.5% ropivacaine with 5 mg of dexamethasone and 0.5 μg·kg−1 DEX in USG-DSAPB. Group RD2 had 20 mL of 0.5% ropivacaine with 5 mg of dexamethasone and 1 μg·kg−1 DEX in USG-DSAPB. The primary outcome was sufentanil consumption 72 h after USG-DSAPB. Secondary outcomes were: postoperative pain scores and level of sedation; intraoperative hemodynamics; duration of post-anesthesia care unit (PACU) stay; prevalence of moderate-to-severe pain; one-time puncture success; procedure time of blockade; time to first rescue analgesia; requirement of rescue analgesia; satisfaction scores of patients and surgeons; duration of hospital stay; adverse events; prevalence of chronic pain; quality of postoperative functional recovery.ResultsCompared with the RD1 group, the visual analog scale score for coughing was significantly lower at 4, 8, 12 h and sufentanil consumption was significantly lower at 4, 8, 12, 24, and 48 h after surgery in the RD2 group (P &lt; 0.05). The time to first rescue analgesia was significantly longer in the RD2 group (P &lt; 0.05). The requirement for rescue analgesia was significantly higher in the RD1 group (P &lt; 0.05). The prevalence of moderate-to-severe pain, number of patients using vasoactive agents, duration of PACU stay, as well as consumption of propofol, remifentanil, and DEX were significantly lower in the RD2 group (P &lt; 0.05). There were no significant differences between the two groups with respect to one-time puncture success, procedure time of blockade, total dermatomal spread, satisfaction scores of patients and surgeons, postoperative complications, duration of hospital stay, 40-item Quality of Recovery questionnaire (QoR-40) score, or prevalence of chronic pain (P &gt; 0.05).ConclusionsWe discovered that 1 μg·kg−1 (not 0.5 μg·kg−1) DEX combined with 20 mL of 0.5% ropivacaine and 5 mg of dexamethasone in USG-DSAPB could provide superior postoperative analgesia for patients undergoing MRM. However, the quality of postoperative functional recovery and prevalence of chronic pain were similar.Clinical Trial Registration:http://www.chictr.org.cn/showproj.aspx?proj=54929, identifier: ChiCTR2000033685.

Background: Ultrasound-guided serratus anterior plane block (USG-SAPB) has been used for pain management of patients undergoing modified radical mastectomy (MRM), but evidence supporting the adjuvant analgesic benefits is limited. We explored the efficacy and safety of preemptive use of different concentrations of dexmedetomidine and ropivacaine in USG-SAPB for patients undergoing MRM.Patients and methods: Ninety-five female patients were randomly allocated to RD1 and RD2 groups. USG-SAPB was performed before anesthesia induction. Consumption of sufentanil, postoperative pain scores, and level of sedation were recorded 1–72 h postoperatively. Intraoperative hemodynamics, PACU length of stay, incidence of moderate-severe pain, one-time puncture success, block procedure time, time to first rescue analgesia, satisfaction scores of patients and surgeons, hospital length of stay, adverse events, the prevalence of chronic pain, and quality of postoperative functional recovery were recorded.Results: Dynamic VAS was significantly lower at 4, 8, and 12 h after surgery and sufentanil need was significantly lower at 4, 8, 12, 24, and 48 h after surgery in the RD2 group (P<0.05). The incidence of moderate-severe pain was significantly lower in the RD2 group (P<0.05). Time to first rescue analgesia was significantly longer in the RD2 group (P=0.047). Consumption of propofol, remifentanil, dexmedetomidine, use of vasoactive agents, and PACU length of stay (LOS) were significantly reduced in RD2 patients (P<0.05). There were no significant differences between the two groups with respect to procedural variables or satisfaction scores of patients and surgeons, and/or postoperative complications. The hospital LOS, global QoR-40, and prevalence of chronic pain were comparable.Conclusions: Use of 1 μg/kg dexmedetomidine and ropivacaine in USG-SAPB can provide superior postoperative analgesia for patients undergoing MRM without additional adverse effects, and result in similar quality of postoperative functional recovery and prevalence of chronic pain.