Effects of ultrasound-guided paravertebral block on MMP-9 and postoperative pain in patients undergoing VATS lobectomy: a randomized, controlled clinical trial

Haichen Chu, He Dong, Yongjie Wang, Zejun Niu, Haichen Chu, He Dong, Yongjie Wang, Zejun Niu

Abstract

Background: Local anesthesia can reduce the response to surgical stress and decrease the consumption of opioids, which may reduce immunosuppression and potentially delay postoperative tumor recurrence. We compared paravertebral block (PVB) combined with general anesthesia (GA) and general anesthesia regarding their effects on postoperative pain and matrix metalloproteinase-9 (MMP-9) after video-assisted thoracoscopic surgery (VATS) lobectomy.

Methods: 54 patients undergoing elective VATS lobectomy at a single tertiary care, teaching hospital located in Qingdao between May 2, 2018 and Sep 28, 2018 were randomised by computer to either paravertebral block combined with general anesthesia or general anesthesia. The primary outcomes were pain scores at rest and on cough at 1, 4, 24, and 48 h after surgery. The secondary outcome were plasma concentrations of MMP-9, complications, and length of postoperative hospital stay.

Results: 75 were enrolled to the study, of whom 21 were excluded before surgery. We analyzed lobectomy patients undergoing paravertebral block combined with general anesthesia (n = 25) or general anesthesia (n = 24). Both groups were similar regarding baseline characteristics. Pain scores at rest at 4 h and 24 h, on cough at 4 h were lower in PVB/GA group, compared with GA group (P < 0.05). There were no difference in pain scores at rest at 1 h, 48 h and on cough at 1 h, 24 h, and 48 h between groups. Patients in the PVB/GA group showed a greater decrease in plasma MMP-9 level at T1 and T2 after VATS lobectomy (P < 0.05). Postoperative complications and length of stay did not differ by anesthetic technique.

Conclusions: The paravertebral block/general anesthesia can provide statistically better pain relief and attenuate MMP-9 response to surgery and after VATS lobectomy. This technique may be beneficial for patients to recover rapidly after lung surgery and reduce postoperative tumor recurrence.

Trial registration: Chinese Clinical Trial registration number ChiCTR1800016379. Registered 28 May 2018.

Keywords: Matrix metalloproteinase-9; Operative; Pain; Paravertebral anesthesia; Video-assisted thoracoscopic lobectomy.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Protocol for patient enrolment in the study groups. Randomized controlled trial comparing PVB/GA versus GA for VATS lobectomy. PVB = paravertebral block; GA = general anesthesia; VATS = video-assisted thoracoscopic surgery
Fig. 2
Fig. 2
Postoperative pain scores at rest. Pain was assessed by the use of a VAS ranging from 0 to 10 at 1, 4, 24, 48 h after surgery for PVB patients (black bar) and GA patients (gray bar), respectively. VAS scores at rest at 4, 24 h after lobectomy were significantly lower in the PVB group than in the GA group. *Statistical significance (P < 0.05). Data are expressed as mean ± standard deviation. VAS = visual analogue scale; PVB = paravertebral block; GA = general anesthesia
Fig. 3
Fig. 3
Postoperative pain scores on cough. Pain was assessed by the use of a VAS ranging from 0 to 10 at 1, 4, 24, 48 h after surgery for PVB patients (black bar) and GA patients (gray bar), respectively. VAS scores on cough at 4 h after lobectomy were significantly lower in the PVB group than in the GA group. *Statistical significance (P < 0.05). Data are expressed as mean ± standard deviation. VAS = visual analogue scale; PVB = paravertebral block; GA = general anesthesia
Fig. 4
Fig. 4
Plasma concentration of measured MMP-9 in lung cancer patients receiving PVB combined general anesthesia or only general anesthesia. *P < 0.05 in the PVB group compared with GA group. MMP-9 = matrix metalloproteinase-9; PVB = paravertebral block; GA = general anesthesia

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