IMPACT OF PARAVERTEBRAL BLOCKADE ON THE COURSE OF EARLY POSTOPERATIVE PERIOD FOLLOWING SURGICAL INTERVENTION FOR LUNG MALIGNANCIES UNDER INHALED SEVOFLURANE ANESTHESIA

Abstract

The aim of the study is to investigate the impact of paravertebral blockade on the quality of anti-stress protection of general inhalation anaesthesia based on sevoflurane during operations in patients with lung malignancy. Material and methods. We examined 60 individuals of an average age 55±5.6 years, whose physical status was assessed as class II – III according to the ASA classification. The patients underwent open surgical procedures, including frontal or pneumonectomy, or partial lung resection. The patients were divided into 2 groups depending on the method of anaesthesia: SF group (sevoflurane) (n = 29) received inhaled anaesthesia with sevoflurane; SF+PVB group (n = 31) received the combination of inhaled anaesthesia with PVB. The following indicators were assessed: time of the first administration of the analgesic after surgery, pain intensity by the visual analogue scale (VAS), perfusion systemic pressure (PST), cardiac index (CI), oxygen content in arterial and venous blood, blood lactate levels, indicators of circulatory energy efficiency, cortisol, insulin and HOMA index levels. Indicators were recorded before the surgical operation, at the wake-up stage, on the 1st and 5th days following the operation. Results. In the SF+PVB group, the intensity of pain in the postoperative period was significantly lower than in the SF group. In the SF+PVB group, there was no necessity for administering narcotic analgesics on the first day, while in the SF group, the dose of morphine was 0.27±0.04 mg/kg∙day, the first administration was performed 65.5±10.3 minutes after surgery. CI during surgery and in a day was significantly higher in the SF+PVB group, and the arteriovenous difference in oxygen content was significantly lower. The energy efficiency of blood circulation at the same stages was significantly higher in the SF+PVB group. In the same group, there was a significantly lower concentration of markers of stress responses (cortisol levels and HOMA index). Conclusions. The use of paravertebral blockade under the general anaesthesia based on sevoflurane during operations in patients with lung malignancies contributes to a significant reduction in the pain intensity in the postoperative period; eliminates the need to use narcotic analgesics; provides significantly more stable hemodynamics and significantly more adequate oxygen supply during the operation and in the postoperative period; significantly reduces the intensity of stress reactions as well as significantly improves the energy efficiency of blood circulation.