Discussion
thoracic paravertebral block, Chronic post-surgical pain, tumor, ESPB, thoracic epidural block, opioid nausea and vomiting side effects, CPSP, pain, lung cancer, cough, agitation, infection, PONV
LUNG CANCER, INFECTION, TUMOR, TUMOR RECURRENCE
In recent years, with the popularization of computed tomography (CT), the detection rate of early lung cancer is increasing [ESPB under ultrasound guidance is a new type of interfascial plane block technology, which is considered to be a safer, less invasive and less difficult to operate in the replacement of thoracic epidural block and thoracic paraververtebra block for chest region analgesia [The results of this study showed that compared with patients in group A, patients in group B had lower NRS scores at rest and cough at 2 h, 6 h, 12 h, 24 and 48 h after operation, significantly reduced frequency of of PCIA use and the frequency of rescue analgesia at 24 h after operation, and had higher satisfaction score with pain management. According to the study of Ciftci et al. [The results of this study showed that the incidence of PONV at 24 h after operation and agitation during anesthesia recovery in group B was lower than that in group A, which may be because ultrasound-guided ESPB has a good analgesic effect on patients undergoing VATS surgery, reduces the dosage of opioids, and thus reduces the occurrence of opioid nausea and vomiting side effects. Fields et al. [Chronic post-surgical pain (CPSP) refers to the pain that persists for 3 months or more after operation. The pain is mainly confined to the area of surgical injury or the corresponding innervated area, and it is necessary to exclude the pain problems existing before surgery, and the pain caused by infection and tumor recurrence [There are some shortcomings in this study. First, this study used a single ultrasound-guided ESPB with a unilateral injection of 0.375% ropivacaine 30mL at the T5 segment. No comparative study was performed on other concentrations of ropivacaine, other doses, other local anesthetics, and continuous ESPB infusion. Second, this study only compared two analgesia methods, ESPB combined with general anesthesia group and general anesthesia group, and did not compare with other analgesia methods for patients undergoing thoracoscopic lobectomy (such as epidural block, thoracic paravertebral block, serratus anterior plane block, etc.), which had certain limitations. Third, We did not analyze the pathological type of the tumor and whether patients underwent chemotherapy or radiotherapy 3 or 6 months after the operation. Therefore, we were unable to explore the effect of differences in chemotherapy or radiotherapy on CPSP between the two groups of patients, and such differences may have distorted the results of this study. Further studies are required to address these limitations.