Randomized Controlled Trial
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2024; 16(1): 196-204
Published online Jan 27, 2024. 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
Ying-Fen Xiong, Ben-Zhong Wei, Yu-Feng Wang, Xiao-Feng Li, Cong Liu
Ying-Fen Xiong, Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Ben-Zhong Wei, Department of Anesthesiology, Nanjing Gulou Hospital Group Yizheng Hospital, Yangzhou 211400, Jiangsu Province, China
Yu-Feng Wang, Nuclear Medicine Department, Xuzhou Cancer Hospital, Xuzhou 221000, Jiangsu Province, China
Xiao-Feng Li, Department of Radiology, Xuzhou Cancer Hospital, Xuzhou 221000, Jiangsu Province, China
Cong Liu, Department of Minimally Invasive Oncology, Xuzhou New Health Hospital (Xuzhou Hospital Affiliated to Jiangsu University), Xuzhou 221000, Jiangsu Province, China
Co-first authors: Ying-Fen Xiong and Ben-Zhong Wei.
Author contributions: Xiong YF and Wei BZ proposed the concept of this study; Liu C validated this study; Xiong YF and Wei BZ jointly wrote the first draft; Wang YF contributed to data collection; Li XF contributed to formal analysis; Xiong YF and Wei BZ participated in the survey; Liu C and Li XF contributed to the methods; Wang YF contributed to the visualization of this study. All authors collectively guided the research, reviewed, and edited the manuscript. Xiong YF and Wei BZ have made equal contributions to this work as co-first authors. It has been decided to designate Xiong YF and Wei BZ as co-first authors for three main reasons. Firstly, this study was conducted as a collaborative effort, warranting the designation of co-first authors. The authors accurately reflect the distribution of responsibilities and burdens associated with the time and effort required to complete the research and final manuscript. Designating two co-first authors will ensure effective communication and management of post-submission matters, thereby enhancing the quality and reliability of the paper. Secondly, the co-first authors from the research team possess diverse expertise and skills from different fields, and their designation best reflects this diversity. It also facilitates the most comprehensive and in-depth exploration of the research topic, ultimately enriching readers' understanding by providing various expert perspectives. Thirdly, Xiong YF and Wei BZ have made substantial and equal contributions throughout the research process. Selecting these researchers as co-first authors acknowledges and respects their equal contributions, showcasing the collaborative and teamwork spirit within this study. We believe that designating Xiong YF and Wei BZ as co-first authors is fitting for our manuscript as it accurately reflects the collaborative spirit, equal contributions, and diversity within our team.
Institutional review board statement: This study has been reviewed and approved by the Medical Ethics Committee of the First Affiliated Hospital of Nanchang University.
Clinical trial registration statement: This study is registered in https://www.researchregistry.com. The registration identification number is Researchregistry9712.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors declare that there is no disclosure of interest relationship.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cong Liu, MSc, Attending Doctor, Department of Minimally Invasive Oncology, Xuzhou New Health Hospital (Xuzhou Hospital Affiliated to Jiangsu University), No. 108 Benteng Avenue, Gulou District, Xuzhou City, Jiangsu Province, Xuzhou 221000, Jiangsu Province, China. xmybdr@126.com
Received: November 6, 2023
Peer-review started: November 6, 2023
First decision: November 16, 2023
Revised: November 20, 2023
Accepted: December 11, 2023
Article in press: December 11, 2023
Published online: January 27, 2024
Processing time: 79 Days and 21.4 Hours
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: Transarterial chemoembolization; Microwave ablation; Paravertebral block; Visual analog scale; Sufentanil; Inflammatory markers

Core Tip: Paravertebral block (PVB) provides effective postoperative analgesia and reduces inflammatory responses in patients undergoing transarterial chemoembolization combined with microwave ablation for advanced gastric cancer and liver metastasis. In a study comparing PVB with intravenous analgesia, the PVB group exhibited lower pain scores, reduced sufentanil consumption, and fewer adverse events. Additionally, the PVB group showed decreased levels of inflammatory markers, indicating improved postoperative comfort and recovery. PVB is a valuable technique for managing pain and inflammation in this patient population.