title: [Effect of ultrasound guided patient-controlled paravertebral block on pulmonary function in patients with multiple fractured ribs].
abstract: Objective:To investigated the effects of patient controlled intravenous analgesia and ultrasound guided patient-controlled paravertebral block on pulmonary function in patients with multiple fractured ribs.Methods:From May 2015 to March 2016, 60 patients with multiple rib fractures in Ningbo NO.6 Hospital with American Society of Anesthesiologists Ⅱ-Ⅲ underwent internal fixation, including 30 males and 30 females aged from 16 to 70 years(mean age (54.6±15.2) years). All patients were randomly divided into 2 groups (n=30 each): patient controlled intravenous analgesia(PCIA) group and patient controlled thoracic paravertebral block(PCPB) group.PCIA solution contained sufentanil 2 μg/kg in 100 ml of normal saline.The PCIA pump was set up to deliver a 2 ml bolus dose with 15 minutes lockout interval and background infusion at 2 ml/hour.In PCPB group, the patients received paravertebral injection of 0.2% ropivocaine 15 ml on the corresponding area of fractured side under ultrasound guidance at the end of operation, and then received PCPB.PCPB solution contained 0.75% ropivacaine 67 ml in 250 ml of normal saline, and the pump was set up to deliver a 5 ml bolus dose, with 15 minutes lock out interval and background infusion at 5 ml/hour. Both analgesia lasted to 72 hours after operation.Before the operation, at 30 minutes, 60 minutes, 1 day, 2 days, 3 days after analgesia, arterial blood samples were collected to test the levels of pH, PaO2, PaCO2, PaO2/FiO2and PA-aDO2. The pulmonary function was also examined before and 3 days after the operation through FEV1and FEV1%.Results:Compared with PCIA group at 30 minutes, 60 minutes, 1 day, 2 days, 3 days after analgesia, the level of PaO2((85.1±9.7)mmHgvs.(72.4±12.3)mmHg, (90.3±12.4)mmHgvs.(73.5±7.8)mmHg, (94.2±8.2)mmHgvs.(86.1±5.6)mmHg, (98.5±7.0)mmHgvs. (88.8±7.5)mmHg, (99.6±9.8)mmHgvs. (91.3±8.6)mmHg,P<0.05)) and PaO2/FiO2were significantly increased ((405.1±46.0)mmHgvs. (340.1±58.9)mmHg, (430.5±59.1)mmHgvs. (344.0±65.4)mmHg, (448.3±39.1)mmHgvs. (410.1±26.7)mmHg, (460.1±33.5)mmHgvs. (423.2±36.5)mmHg, (465.1±28.2)mmHgvs. (435.1±40.8)mmHg,P<0.05)), the level of PA-aDO2was decreased ((22.9±4.6)mmHgvs. (36.6±5.1)mmHg, (17.7±4.7)mmHgvs. (34.5±2.9)mmHg, (13.8±4.1)mmHgvs. (21.9±3.2)mmHg, (13.5±4.6)mmHgvs. (19.2±3.8)mmHg, (12.4±2.0)mmHgvs. (17.7±2.4)mmHg,P<0.05)), and FEV1, FEV1% were significantly increased at 3 days after operation in PCPB group ((2.9±0.4)mmHgvs.(2.2±0.5)mmHg, (78.1±4.7)mmHgvs.(64.8±4.3)mmHg;P<0.01)).Conclusion:Ultrasound guided patient-controlled paravertebral block improves the arterial oxygenation function and accelerates the recovery of pulmonary function in patients with multiple-fractured ribs after internal fixation operation.
authors.affiliation: *Department of Anesthesiology, Ningbo NO.6 Hospital, Ningbo 315040, China.
authors.forename: Y Y
authors.initials: YY
authors.lastname: Ge
authors.forename: X Z
authors.initials: XZ
authors.lastname: Wang
authors.forename: N
authors.initials: N
authors.lastname: Yuan
authors.forename: L Y
authors.initials: LY
authors.lastname: Yuan
authors.forename: W H
authors.initials: WH
authors.lastname: Ma
authors.forename: Y
authors.initials: Y
authors.lastname: Hu
mesh_terms: D000328:Adult; D000368:Aged; D000577:Amides / Q000627:therapeutic use; D000698:Analgesia; D016058:Analgesia, Patient-Controlled; D000779:Anesthetics, Local / Q000627:therapeutic use; D005260:Female; D005593:Fracture Fixation, Internal; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain; D012253:Rib Fractures / Q000601:surgery*; D000077212:Ropivacaine; D017409:Sufentanil / Q000627:therapeutic use; D018084:Ultrasonography, Interventional
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D017409:Sufentanil