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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.
OBJECTIVE: 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).
CONCLUSIONS: 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.
OBJECTIVE: 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).
CONCLUSIONS: 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.
摘要：
背景：经动脉化疗栓塞（TACE）联合微波消融（MWA）是晚期胃癌和肝转移患者的有效治疗策略。然而,它可能导致严重的术后疼痛和炎症反应。椎旁阻滞（PVB）是一种局部麻醉技术，可为胸部和腹部区域提供镇痛作用。
目的：评价PVB对TACE联合MWA治疗进展期胃癌肝转移患者术后镇痛及炎性反应的影响。
方法：将60例患者随机分为PVB组和对照组。PVB组术前接受超声引导下使用0.375%罗哌卡因的PVB,对照组给予舒芬太尼静脉镇痛。主要结果是6小时疼痛的视觉模拟量表（VAS）评分，12h,24h,和48小时后的程序。次要结果是使用的舒芬太尼剂量，不良事件的发生率，和炎症标志物水平（白细胞计数，中性粒细胞百分比，C反应蛋白,和降钙素原）在手术前后。
结果：PVB组在6h时VAS评分明显降低，12h,24h,术后48h与对照组比较(P<0.05)。PVB组的舒芬太尼消耗量也显著降低，恶心发生率也较低，呕吐,呼吸抑制优于对照组(P<0.05)。与对照组相比,术后24h和48h，PVB组炎症标志物水平明显降低（P<0.05）。
结论：PVB能有效减轻晚期胃癌肝转移患者TACE联合MWA治疗术后疼痛和炎性反应，提高患者术后舒适度和恢复。
目的：评价PVB对TACE联合MWA治疗进展期胃癌肝转移患者术后镇痛及炎性反应的影响。
方法：将60例患者随机分为PVB组和对照组。PVB组术前接受超声引导下使用0.375%罗哌卡因的PVB,对照组给予舒芬太尼静脉镇痛。主要结果是6小时疼痛的视觉模拟量表（VAS）评分，12h,24h,和48小时后的程序。次要结果是使用的舒芬太尼剂量，不良事件的发生率，和炎症标志物水平（白细胞计数，中性粒细胞百分比，C反应蛋白,和降钙素原）在手术前后。
结果：PVB组在6h时VAS评分明显降低，12h,24h,术后48h与对照组比较(P<0.05)。PVB组的舒芬太尼消耗量也显著降低，恶心发生率也较低，呕吐,呼吸抑制优于对照组(P<0.05)。与对照组相比,术后24h和48h，PVB组炎症标志物水平明显降低（P<0.05）。
结论：PVB能有效减轻晚期胃癌肝转移患者TACE联合MWA治疗术后疼痛和炎性反应，提高患者术后舒适度和恢复。
