关键词: 肋间神经； ,  , 硬膜外阻滞； ,  , 羟考酮； ,  , 食管癌根治术； ,  , 疼痛； ,  , 呼吸指标

Abstract: Objective    To study the effects of thoracoscopic direct vision intercostal nerve micropuncture injection and T8-9 epidural block  combined with oxycodone（T-E-O) triple process on analgesia and respiratory recovery after radical resection of esophageal cancer by thoracic laparoscopy. Methods   One hundred and forty patients of both sexes, of American Society of Anesthesiologists (ASA) physical status I or II, were scheduled for elective radical resection of esophageal cancer undergoing thoracoscope and laparoscopic radical surgery of esophageal cancer, and then were randomly divided into 2 groups (n=70 each): a control group (group C) and a T-E-O triple process group (group T). Sufentanil 0.1 μg/kg in group C or oxycodone 0.1 mg/kg in group T were intravenously injected at 10 min before the end of operation. T8-9 epidural block was applied before anesthesia induction, and thoracoscopic direct vision intercostal nerve micropuncture injection in the chest before closing chest was performed. All patients sent to Postanesthesia Care Unit (PACU) after surgery were extubated and sent to ward after resuscitation. Analgesic pump was connected at the end of operation in two groups. Sufentanil 0.05 μg/kg in group C or oxycodone 0.05 mg/kg in group T were intravenously injected when visual analogue scale score(VAS) ≤３. At 1min before one-lung ventilation(OLV) (t0), before re-expansion of the collapsed lung (t1), at 30 min after re-expansion of the collapsed lung (t2), into PACU (t3), before extubation (t4), pain after extubation (t5), after the analgesic injection (t6), when leaving PACU (t7), blood gas analysis was performed, oxygenation index (OI), alveolar-arterial oxygen gradient(A-aDO2) and respiratory index (RI) were calculated, the number of rescue analgesia when in PACU, the recovery time, tracheal extubation time and PACU residence time were collected,  the occurrence of abnormal lung function and agitation were recorded.    Results    Compared with group C, OI was significantly increased, A-aDO2  and RI was reduced at t5-7(P<0.05), and the number of requirements for rescue analgesia, the recovery time, tracheal extubation time and PACU residence time, the occurrence of abnormal lung function and agitation were decreased in group T (P<0.05).    Conclusions    T-E-O triple process can significantly relieve pain and improve respiratory function during the recovery period after radical laparoscopic surgery for esophageal cancer.

Key words: Intercostal nerve block; ,  Epidural blocks; ,  Oxycodone; ,  Radical surgery of esophageal cancery; ,  , Pain; ,  , Respiratory index