椎旁阻滞对肺癌根治术患者术后镇痛效果及外周血肿瘤标志物水平的影响

BACKGROUND AND OBJECTIVE: Perioperative management of pain associated with the prognosis of cancer patients. Optimization of perio-perative analgesia method, then reduce perioperative stress response, reduce opioiddosage, to reduce or even avoid systemic adverse reactions and elevated levels of tumor markers. Serum levels of tumor markers in patients with lung cancer are closely related to tumor growth. Clinical research reports on regional anesthesia effect on tumor markers for lung cancer are still very little in domesticliterature. The aim of this study is to evaluate the effects of thoracic paraverte-bral block on postoperative analgesia and serum level of tumor marker in lung cancer patients undergoing video-assisted thoracoscopic surgery. METHODS: Lung cancer patients undergoing video-assisted thoracoscopic surgery were randomly divided into 2 groups (n=20 in each group). The patients in group G were given only general anesthesia. The thoracic paravertebral blockade (PVB) was performed before general anesthesia in patients of group GP. The effect of PVB was judged by testing area of block. Patient controlled intravenous analgesia (PCIA) pump started before the end of surgery in 2 groups. Visual analogue scale (VAS) score was recorded after extubation 2 h (T1), 24 h (T2) and 48 h (T3) after surgery and the times of PCIA and the volume of analgesic drugs used were recorded during 48 h after surgery. The serum levels of carcino-embryonic antigen (CEA), carbohydrate antigen 199 (CA199), carbohydrate antigen 125 (CA125), neuron-specific enolase (NSE), cytokeratin 19 fragment (CYFRA21-1) and squamous cell carcinoma (SCC) in 40 lung cancer cases undergoing video-assisted thoracoscopic lobectomy were measured before operation and 24 h after operation. RESULTS: Forty American Society of Anesthesiologists (ASA) physical status Ⅰ or Ⅱ patients, aged 20 yr-70 yr, body mass index (BMI) 18 kg/m(2)-25 kg/m(2), scheduled for elective video-assisted thoraeoscopic lobectomy, VAS scores at T1 and T2 were lower in group GP than those in group G (P=0.013, P=0.025, respectively), PCIA times during postoperative analgesia 24 h and 48 h were lower in group GP than those in group G (P=0.021, P=0.026, respectively), analgesic volume used during postoperative analgesia 24 h and 48 h were lower in group GP than those in group G (P=0.006, P=0.011, respectively). The level of tumor marker at post-operative were not significantly decreased than preoperative in both groups (P > 0.05). CONCLUSION: Patients in group G feel more painful and a higher dosage of dezocine is required to relieve the pain than group GP. Thoracic paravertebralblock has no influence on serum level of tumor marker in lung cancer patients undergoing video-assisted thoraeoscopic lobectomy.