Paravertebral block's effect on analgesia and inflammation in advanced gastric cancer patients undergoing transarterial chemoembolization and microwave ablation

Ying-Fen Xiong; Ben-Zhong Wei; Yu-Feng Wang; Xiao-Feng Li; Cong Liu

doi:10.4240/wjgs.v16.i1.196

Paravertebral block's effect on analgesia and inflammation in advanced gastric cancer patients undergoing transarterial chemoembolization and microwave ablation

World J Gastrointest Surg. 2024 Jan 27;16(1):196-204. doi: 10.4240/wjgs.v16.i1.196.

Authors

Ying-Fen Xiong¹, Ben-Zhong Wei², Yu-Feng Wang³, Xiao-Feng Li⁴, Cong Liu⁵

Affiliations

¹ Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China.
² Department of Anesthesiology, Nanjing Gulou Hospital Group Yizheng Hospital, Yangzhou 211400, Jiangsu Province, China.
³ Nuclear Medicine Department, Xuzhou Cancer Hospital, Xuzhou 221000, Jiangsu Province, China.
⁴ Department of Radiology, Xuzhou Cancer Hospital, Xuzhou 221000, Jiangsu Province, China.
⁵ Department of Minimally Invasive Oncology, Xuzhou New Health Hospital (Xuzhou Hospital Affiliated to Jiangsu University), Xuzhou 221000, Jiangsu Province, China. xmybdr@126.com.

Abstract

Background: Transarterial chemoembolization (TACE) combined with microwave ablation (MWA) is an effective treatment strategy for patients with advanced gastric cancer and liver metastasis. However, it may cause severe postoperative pain and inflammatory responses. The paravertebral block (PVB) is a regional anesthetic technique that provides analgesia to the thoracic and abdominal regions.

Aim: To evaluate the effect of PVB on postoperative analgesia and inflammatory response in patients undergoing TACE combined with MWA for advanced gastric cancer and liver metastasis.

Methods: Sixty patients were randomly divided into PVB and control groups. The PVB group received ultrasound-guided PVB with 0.375% ropivacaine preoperatively, whereas the control group received intravenous analgesia with sufentanil. The primary outcome was the visual analog scale (VAS) score for pain at 6 h, 12 h, 24 h, and 48 h after the procedure. Secondary outcomes were the dose of sufentanil used, incidence of adverse events, and levels of inflammatory markers (white blood cell count, neutrophil percentage, C-reactive protein, and procalcitonin) before and after the procedure.

Results: The PVB group had significantly lower VAS scores at 6 h, 12 h, 24 h, and 48 h after the procedure compared with the control group (P < 0.05). The PVB group also had a significantly lower consumption of sufentanil and a lower incidence of nausea, vomiting, and respiratory depression than did the control group (P < 0.05). Compared with the control group, the PVB group had significantly lower levels of inflammatory markers 24 h and 48 h after the procedure (P < 0.05).

Conclusion: PVB can effectively reduce postoperative pain and inflammatory responses and improve postoperative comfort and recovery in patients with advanced gastric cancer and liver metastasis treated with TACE combined with MWA.

Keywords: Inflammatory markers; Microwave ablation; Paravertebral block; Sufentanil; Transarterial chemoembolization; Visual analog scale.