关键词: 超声引导； , 椎旁阻滞； , 达芬奇机器人； , 恢复质量； , 围术期镇痛

Abstract:

Objective To evaluate the effects of ultrasound ⁃ guided thoracic and lumbar paravertebral block on the perioperative analgesia and early postoperative recovery in patients undergoing robot⁃assisted nephrec⁃ tomy. Methods Eighty patients receiving elective robot⁃assisted laparoscopic nephrectomy were randomly divided into two groups with 40 patients in each group. The observation group was performed under general anesthesia after paravertebral block，and the control group was performed under general anesthesia. MAP and HR at different time points were recorded. The intraoperative dosage of remifentanil，eye opening time，respiratory recovery time，extu⁃ bation time，exiting room time，Ricker sedation ⁃agitation score（SAS）and VAS score during anesthesia recovery were recorded. The resting and coughing VAS scores at different time points postoperatively were recorded. The postoperative quality of recovery（QoR⁃40）scores at 1 day before surgery，1 day after surgery and 2 days after surgery were recorded. The incidence of effective pressure of postoperative analgesia pump，remedial analgesia，and related adverse reactions were recorded. Results Compared with the control group，MAP and HR in the observation group were more stable（P < 0.05）. The amount of intraoperative remifentanil in the observation group was signifi⁃ cantly reduced，the SAS score and VAS score during anesthesia recovery period in the observation group was lower， the time of eye opening，respiratory recovery，extubation and exit from the room were shorter in the observation group（P < 0.05）. The resting and coughing VAS scores of the observation group at 6 h，12 h and 24 h after surgery were significantly lower（P < 0.05）. The scores of all items and total scores of QoR⁃40 scale in observation group increased at 1 d after surgery（P < 0.05），physical comfort，emotional state，behavioral independence and total score of QoR⁃40 scale increased at 2 d after surgery（P < 0.05）. Conclusion Thoracic and lumbar paravertebral block could provide better perioperative analgesia for robot ⁃assisted laparoscopic nephrectomy and contribute to early postoperative recovery.

Key words:

ultrasound?guided, paravertebral block, Da Vinci robot, quality of recovery, periop?erative analgesia