Effect of Ropivacaine Combined with Small Doses of Triamcinolone and Continuous Nerve Block of Unilateral Paravertebral Canal Guided by Ultrasound on Metastasis after Radical Treatment of Lung Cancer

Abstract

Continuous nerve block of unilateral paravertebral canal is one of the most reliable and the most commonly performed techniques to control intra- and postoperative pain. It is the technique of injecting local anaesthetic alongside the thoracic vertebra close to where the spinal nerves emerge from the intervertebral foramen. This produces unilateral, segmental, somatic, and sympathetic nerve blockade, which is effective for anaesthesia and in treating acute and chronic pain of unilateral origin from the chest and abdomen. Ultrasound guidance with or without nerve stimulator has reduced the amount of local anaesthetics (LA) to achieve a successful block, which may minimize complications of continuous nerve block of unilateral paravertebral canal. Previous studies have suggested that continuous nerve block of unilateral paravertebral canal with ropivacaine combined with small doses of triamcinolone was effective to achieve sensory and motor block after lung cancer surgery. Previous studies have used a fixed large dose in different volumes and concentrations for a nerve block, infraclavicular block, axillary block, and humeral canal block. The results of these studies with the respects of onset time, successful rate, and block duration were not consistent. Various factors, including the technique used, the anatomic aspects of the injection, and the pharmacodynamics aspect of drug, may influence the results. We tested the hypothesis that 50,25,10 mg ropivacaine and 50,25,10 mg triamcinolone of three combinations of volumes and concentrations for ultrasound-guided continuous nerve block of unilateral paravertebral canal produce different effects in the aspect of survival rate. Here, the drug effect was analyzed using the cross cluster K-nearest neighbors (KNN). The whole experimentation was carried out under MATLAB environment.

Ultrasound-guided thoracic paravertebral nerve block in patients undergoing radical mastectomy

“…Previous studies [2, 23,24] have suggested that patients who receive ultrasound-guided thoracic paravertebral nerve block combined with general anesthesia are hemodynamically stable, thus indicating that ultrasound-guided thoracic paravertebral nerve blocks can effectively inhibit the stress response of patients [25][26][27]. Once the stress response occurs, patients experience a number of symptoms, including insulin resistance (inducing gluconeogenesis and hepatic glycogenolysis) and the massive secretion of hormones such as COR, which leads to a rapid increase in blood glucose in patients [7,28]. To avoid these phenomena, we selected ultrasound-guided thoracic paravertebral nerve block in the present study to inhibit the intraoperative stress response of patients, thus achieving excellent outcomes.…”

Trial watch: local anesthetics in cancer therapy

“…Less increase in IL-6. 207 Liver Ropivacaine (bolus+ infiltration) Sixty patients included (20 with tramadol, 20 with ropivacaine, 20 with fentanyl) Ropivacaine increased survival ( p = .029) 201 Lung Ropivacaine (paravertebral) Forty patients involved to receive paravertebral/propofol vs sevoflurane Lower VEGF and TGF-β concentration ( p < .05) 208 Lung Ropivacaine (paravertebral) One hundred and fifty-nine patients randomized to receive ropivacaine (10 mg or 25 mg or 50 mg) No influence on OS 193 Lung Ropivacaine (epidural) Four hundred patients included (200 with epidural) No benefits in RFS or OS 194 Ovary Ropivacaine (intraperitoneal catheter) Forty patients randomized to have intraperitoneal catheter of LA or not Serum cortisol was lower in LA group ( p = .023) 209 Ovary Ropivacaine (intraperitoneal catheter) Forty women involved to receive intraperitoneal catheter or not. Reduction of time to initiate chemotherapy after surgery ( p = .021) 202 Pancreas Lidocaine (intravenous) Five hundred and sixty-three patients randomized to receive lidocaine intravenous (n = 283) or not (n = 280) No association with better OS ( p = .79) or DFS ( p = .44) 195 Prostate Ropivacaine (epidural) Ninety-nine patients randomized ...…”