<p>The Efficacy and Safety of Paravertebral Block Combined with Parecoxib During Video-Assisted Thoracic Surgery: A Randomized Controlled Trial</p>

Abstract

Background: Although video-assisted thoracoscopic surgery (VATS) is increasingly used, the optimal analgesia strategy is still unknown. We explore the efficacy and safety of preemptive ultrasound-guided paravertebral block (PVB) combined with parecoxib during VATS. Methods: Seventy-four patients were divided into two groups. PVBs were performed before anesthesia induction under real-time ultrasound guidance. Visual analog scale (VAS) score with coughing at 48 h after surgery, postoperative sufentanil consumption and level of sedation (LOS) at 1, 4, 8, 12, 24, and 48 h postoperatively, intraoperative hemodynamics, satisfaction scores of patients and surgeons, remedial measures, time to chest tube removed and mobilization, adverse effects and hospital stay length were recorded. We also recorded inflammatory markers, respiratory function and the prevalence of chronic pain after surgery. Results: VAS scores at rest and with coughing during the first 24 h after surgery were significantly lower in the P group (P<0.05). Consumption of sevoflurane, remifentanil, and dexmedetomidine was all significantly reduced in the P group (P<0.05). The consumption of sufentanil within 48 h after surgery, time to first dose and total dose of rescue ketorolac was significantly lower in the P group (P<0.05). The FEV1/FVC ratio was significantly higher in the P group at 1 and 3 d after surgery (P<0.05). Times to chest tube removal and mobilization were significantly shorter in the P group (P<0.05). Compared with the C group, the level of both ACTH and cortisol was significantly reduced in the P group at 1 and 3 d after surgery (P<0.05). Conclusion: PVB combined with parecoxib was associated with better pain relief, decreased sufentanil and ketorolac consumption, less hemodynamic instability, and a lower surgery-related stress response. However, the incidences of chronic pain 3 and 6 months after surgery and the risk of complication except urinary retention were not significantly different between groups.

The effect of parecoxib sodium on postoperative delirium in elderly patients with hip arthroplasty

“…It inhibits the aggregation of leukocytes, reduces the formation of bradykinin, inhibits platelet agglutination, and induces apoptosis and anti-angiogenesis by selectively inhibiting the activity of COX-2, thus producing antipyretic, analgesic, anti-inflammatory, and anti-cancer effects ( Kaduševičius, 2021 ). Studies have shown that in major surgeries such as thoracic surgery and orthopedics, parecoxib sodium can reduce pain levels and postoperative serum inflammatory factor levels, reduce the incidence of adverse reactions such as nausea and vomiting and pulmonary infections, reduce analgesic drug consumption, reduce hemodynamic instability, and reduce surgery-related stress reactions ( Yang et al, 2020 ; Li et al, 2022a ). Basic research has revealed that parecoxib sodium can exert neuroprotective effects by inhibiting and improving mitochondrial dysfunction in the substantia nigra via the COX-2/PGE2 pathway ( Yan et al, 2021 ).…”

Impact of adding opioids to paravertebral blocks in breast cancer surgery patients: A systematic review and meta-analysis

“…The local anesthetic blocks the somatic and sympathetic nerve supply of the dermatome of interest thereby providing postsurgical analgesia[ 27 ]. Its efficacy has been tested in a randomized setting by numerous authors not only for breast surgery but also for thoracic surgeries[ 12 , 28 ]. However, one important limitation of nerve blocks, in general, is the short duration of action of the local anesthetic.…”

Impact of different doses of remifentanil on chronic postsurgical pain after video-assisted thoracic surgery: A propensity score analysis

“…There are many definitions of CPSP, although we defined CPSP as pain at the surgical site (NRS score ≥ 1) that the patient was identified as being related to the surgery, according to previous high-quality studies. [10,16,17]…”