Effect and clinical significance of bilateral thoracic paravertebral block combined with S-ketamine on laparoscopic radical surgery for colorectal cancer.

Abstract

Objective: To analyze the effect of bilateral thoracic paravertebral block (TPVB) combined with s-ketamine on patients undergoing laparoscopic radical surgery for colorectal cancer (CRC).

Methods: The study subjects were 94 patients who visited our hospital for colon cancer and underwent laparoscopic radical surgery from January 2022 to January 2024. The patients were divided into the Control group (n = 33), TPVB group that underwent bilateral TPVB (n = 30) and Combine group that underwent TPVB + s-ketamine (n = 31). The haemodynamic indexes of patients were monitored and compared; the Stress Response Indicators of patients were detected by ELISA, pain at rest and during exercise was assessed by numerical rating scale (NRS), cognitive level was assessed by Mini-Mental State Examination (MMSE), and perioperative daily living ability was assessed by Activity Daily Living (ADL) Scale; quality of life assessed by the 12-item Short-Form Health Survey (SF-12); and the overall patient outcomes were statistically compared.

Results: ➀ Haemodynamic improvement was significantly greater than that in the Control and TPVB groups (P < 0.05). ➁ Stress response indicators (cortisol [COR] and adrenocorticotropic hormone [ACTH]) decreased more markedly in the Combine group than in the Control and TPVB groups (P < 0.05). ➂ The Combine group showed more pronounced declines in resting and exercise-induced NRS scores, as well as more significant increases in ADL and MMSE scores, compared with the Control and TPVB groups (P < 0.05). ➃ Although no significant differences in SF-12 scores were observed among the Control, TPVB, and Combine groups, all three groups exhibited substantial improvements in quality of life at 3, 6, and 9 months post-surgery (P > 0.05). ➄ The Combine group had significantly shorter times to first flatus, first solid food intake, and first defecation, as well as reduced hospital stay duration, propofol dosage, and remifentanil dosage, compared with the TPVB and Control groups (P < 0.05). ➅ The complication rates in the Combine and TPVB groups were significantly lower than those in the Control group (P < 0.05).

Conclusion: TPVB combined with s-ketamine can effectively eliminate patients' pain and stress and improve their haemodynamics, which further promotes patients' postoperative recovery.