Thoracic Paravertebral Block Combined with General Anaesthesia or General Anaesthesia Alone for Thoracoscopic Lung Adenocarcinoma Surgery: A Retrospective Study

Figures & data

Figure 1 Ultrasound image of the thoracic paravertebral block. The red arrow denotes the puncture path of the needle. Compared with the picture above, the pleura in the picture below is being pressed down by the local anaesthetics.

Abbreviations: TM, trapezius muscle; ESM, erector spinae muscle; LCL, lateral costotransverse ligamentum; TP, transverse process; PVS, paravertebral space; LA, local anaesthetics; PP, pleura is pressed down by local anaesthetics.

Figure 2 Flow diagram of the study.

Figure 3 Comparison of Kaplan–Meier survival curves for the 2-year postoperative recurrence-free survival between groups. There were no statistical differences in the 2-year postoperative recurrence-free survival between groups (multivariate hazard ratio 0.706, 95% CI 0.126–3.941, P=0.691).

Abbreviations: group TG, thoracic paravertebral block combined with general anaesthesia; group GA, general anaesthesia alone.

Figure 4 Comparison of the average pain scores 48 h postoperatively between groups. The data are given as mean ± SD, compared with group GA, *P<0.05. Data were compared by independent-sample t-test.

Abbreviations: group TG, thoracic paravertebral block combined with general anaesthesia; group GA, general anaesthesia alone; NRS, numeric rating scale.

Figure 5 Comparison of postoperative early recovery between groups. The first time of postoperative ambulation (A), the duration of chest tube drainage (B), the length of postoperative hospitalization (C). The data are given as mean ± SD, compared with group GA, *P<0.05. Data were compared by independent-sample t-test.

Abbreviations: group TG, thoracic paravertebral block combined with general anaesthesia; group GA, general anaesthesia alone.

Figure 6 Comparison of intraoperative and postoperative sufentanil dosage between groups. The data are given as mean ± SD, compared with group GA, *P<0.01. Data were compared by independent-sample t-test.

Abbreviations: group TG, thoracic paravertebral block combined with general anaesthesia; group GA, general anaesthesia alone.

Table 1 Comparison of Demographic Data and Characteristics in the Two Groups

Characteristics	Group TP (n=86)	Group GA (n=109)	P value
Age, (year)	57.6±8.7	60.1±9.8	0.06^#
Sex, n (%)
Male	51 (59.3)	57 (52.3)	0.33^£
Female	35 (40.7)	52 (47.7)
Weight (kg)	65.2±11.2	63.0±10.6	0.16^#
BMI (kg/m^2)	23.1±1.4	22.8±1.1	0.07^#
Smoking status, n (%)	26(30.2)	37(33.9)	0.65^£
ASA grade, n (%)
I	12 (14.0)	11 (10.1)	0.67^£
II	66 (76.7)	89 (81.6)
III	8 (9.3)	9 (8.3)
PaO2 (mmHg)	86.6±7.9	84.6±8.4	0.10^#
PaCO2 (mmHg)	41.3±5.6	42.5±4.9	0.12^#
Haemoglobin (g/L)	134.8±18.3	133.1±18.6	0.52^#
Sevoflurane (mL)	42.1±6.5	43.3±5.9	0.18^#
Propofol (mg)	906.7±213.9	901.1±198.0	0.85^#
Duration of anaesthesia (min)	166.1 ± 22.3	171.3 ± 23.1	0.12^#
Duration of surgery (min)	134.9 ± 22.2	138.7 ± 19.1	0.19^#
Intraoperative blood loss (mL)	69.7±23.1	73.6±27.6	0.29^#
Urine volume (mL)	123.6±26.8	118.7±24.2	0.19^#
Type of lobectomy, n (%)
Left upper	15 (17.4)	21 (19.3)	0.51^£
Left lower	12 (14.0)	17 (15.6)
Right upper	20 (23.3)	29 (26.6)
Right middle	14 (16.3)	22 (20.2)
Right lower	25 (29.0)	20 (18.3)
Tumour stage, n (%)
I	61 (70.9)	70 (64.2)	0.36^£
II	15 (17.5)	18 (16.5)
III A	10 (11.6)	21 (19.3)
Treatment regime, n (%)
Surgery only	57 (66.3)	75 (68.8)	0.58^Δ
Surgery &chemotherapy	16(18.6)	13 (11.9)
Surgery &radiation	1 (1.2)	2 (1.8)
Surgery&chemotherapy and radiation	0	0
Other treatment	12 (14.0)	19 (17.4)

Notes: The data are given as mean ± SD or n (%). Quantitative variables were compared by ^#independent-sample t; Qualitative variables were compared by ^£Chi-square (χ2) or ^ΔFisher’s exact test.

Abbreviations: TG, thoracic paravertebral block combined with general anaesthesia alone; GA, general anaesthesia alone; BMI, body mass index; ASA, American Society of Anesthesiologists; PaO₂, partial pressure of arterial oxygen; PaCO₂, partial pressure of arterial carbon dioxide; SD, standard deviation.

Table 2 Cox Regression Analysis for Recurrence-Free Survival at Postoperative Year 2

	Univariate			Multivariate
Variables	HR	95% CI	P value	HR	95% CI	P value
Type of anaesthesia
GA	Reference			Reference
TG	0.702	0.235–2.096	0.527	0.706	0.126–3.941	0.691
Tumour stage
I	Reference			Reference
II	0.851	0.184–3.940	0.837	0.136	0.015–1.743	0.077
III	1.467	0.397–5.419	0.566	0.022	0.001–0.734	0.033
Treatment regime
Surgery only	Reference			Reference
Surgery & chemotherapy	0.979	0.212–4.532	0.978	5.372	0.438–65.935	0.189
Surgery & radiation	5.394	0.682–42.657	0.110	17.585	0.641–6482.186	0.080
Other treatment	0.960	0.207–4.443	0.958	159.206	1.953–12,377.670	0.024
ASA status
I	Reference			Reference
II	0.856	0.288–2.548	0.780	1.207	0.119–12.236	0.874
III	0.722	0.089–5.866	0.760	1.170	0.119–11.507	0.893
Sex
Male	Reference			Reference
Female	0.576	0.200–1.660	0.307	0.682	0.183–2.545	0.569
Smoking status
Yes	Reference			Reference
No	0.838	0.263–2.670	0.764	0.682	0.183–2.545	0.569
Age, yr
Age <60	Reference			Reference
Age ≥60	1.154	0.400–3.326	0.791	1.243	0.374–4.131	0.722
IPSD	1.016	0.996–1.036	0.122	1.018	0.990–1.047	0.192

Notes: Only the clinically meaningful clinicopathologic and perioperative variables were included in the univariate and multivariate ananlysis, which were analysed by Cox proportional hazards regression. Associations with P < 0.05 were considered statistically significant.

Abbreviations: TG, thoracic paravertebral block combined with general anaesthesia alone; GA, general anaesthesia alone; ASA, American Society of Anesthesiologists; HR, hazard ratio; CI, confidence interval; IPSD, intraoperative and postoperative sufentanil dosage.

Table 3 Comparison of Side Effects After Operation (n (%))

Indicators	Group TG (n=86)	Group GA (n=109)	P value
Drowsiness	2 (2.3%)	5 (4.6%)	0.47
PONV	3 (3.5%)*	13 (11.9%)	0.03
Itching	1 (1.1%)	7 (6.9%)	0.08
Respiratory depression	1 (1.1%)	4 (3.4%)	0.39
Urinary retention	0	5 (10.3%)	0.07
Hypotension	0	2 (3.4%)	0.50
Bradycardia	0	1 (%)	1.00

Notes: The data are given as n (%). Qualitative variables were compared by Fisher’s exact test. Compared with group GA, *P<0.05.

Abbreviations: TG, thoracic paravertebral block combined with general anaesthesia alone; GA, general anaesthesia alone; PONV, postoperative nausea and vomiting.