Di-san junyi daxue xuebao (Jan 2019)
Effect of thoracic paravertebral block-propofol intravenous balance general anesthesia on serum vascular endothelial growth factor C and transforming growth factor β1 in patients undergoing radical lung cancer resection
Abstract
Objective To compare the effects of thoracic paravertebral nerve block-propofol intravenous balance general anesthesia (PPA) and sevoflurane inhalation balanced general anesthesia (SGA) on the serum concentrations of vascular endothelial growth factor C (VEGF-C) and transforming growth factor β1 (TGF-β1) in the patients undergoing radical resection for non-small cell lung cancer performed via video-assisted thoracoscopy. Methods Lung cancer patients undergoing radical resection were assigned to the PPA(n=23) or SGA(n=23) group. In the PPA group, thoracic paravertebral nerve block anesthetic was performed successfully with local injection of 0.5%ropivacaine(2.0 mg/kg) before induction of anesthesia, anesthesia was maintained with the target controlled infusion (TCI) of propofol (plasma concentration of 2.6~3.2 μg/mL)and intravenous remifentanil. In the SGA group, anesthesia was maintained with 1.0~1.5 (minimum alveolar concentration, MAC) sevoflurane and intravenous remifentanil. We observed opioid consumption intraoperative and 24 h postoperative, the pain scores at 2, 8, 24, 48, 72 h after surgery, as well as the serum concentrations of VEGF-C and TGF-β1 before surgery and 24 h after surgery. Results The amount of intraoperative remifentanil consumption in the PPA group was significantly lower than in the SGA group (P < 0.01), the amount of sufentanil consumption at 24 h postoperatively was significantly lower than in the SGA group (P < 0.01), and the VAS score at 2, 8 and 24 h postoperatively was significantly lower than in the SGA group (P < 0.01). At 24 h after surgery, the serum VEGF-C levels were lower in group PPA compared with the group SGA (629±203 vs 908±222 pg/mL, P=0.030), the serum TGF-β1 levels were lower in group PPA compared with the group SGA (8.37±2.84 vs 10.57±2.47 ng/mL, P=0.021). Conclusion Thoracic paravertebral nerve block-propofol intravenous balance general anesthesia can reduce opioids consumption for patients undergoing radical surgery for lung cancer, improve the postoperative analgesic effect, and reduce the concentration of serum tumor angiogenesis-related factors at 24 h after surgery. It is suggested that thoracic paravertebral nerve block-propofol intravenous balance general anesthesia is better than sevoflurane inhalation balanced general anesthesia for lung cancer patients undergoing radical resection.
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