Objective To study the effect of thoracic paravertebral block combined patient-controlled intravenous analgesia on postoperative analgesia of patients undergoing laparoscopic hepatectomy. Methods Eighty three liver cancer patients, 39 males and 44 females, aged 42 - 61 years, BMI 20 - 27 kg/m2, ASA physical status I or II undergoing laparoscopic hepatectomy from January to December in 2016 were enrolled in this study. According to the postoperative analgesia, all patients were divided into two groups: the combination group (group T, n = 43) who received thoracic paravertebral block (TPVB) combined with patient-controlled intravenous analgesia (PCIA) and the simple group (group S, n = 40) who received PCIA alone. The patients’ numeric rating scale (NRS) 4 h before operation and 24, 72 h or 7 d after operation between the two groups were recorded and compared. The venous blood of patients was collected to detect the ratio of CD4+/CD8+ cells, the levels of serum pain mediators such as neuropeptide Y (NPY), dopamine (DA), and norepinephrine (NE), interleukin IL-1β (IL-1β), interleukin IL-6 (IL-6), and interleukin IL-8 (IL-8) by flow cytometry and ELISA. The amount of sufentanil used and the number of PCIA compressions were recorded, and adverse reactions such as postoperative sleep, pneumonia, and delayed liver function recovery were recorded. Results The NRS scores of group T were significantly lower than those of group S 24, 72 h and 7 d after surgery (P < 0.05). The levels of IL-1β, IL-6 and IL-8 in group T were significantly lower than those in group S 24 and 72 h after operation (P < 0.05). The concentrations of SP, NPY, DA and NE were significantly lower than those in group S (P < 0.05). Furthermore, the CD4+/CD8+ in group T was significantly higher than that in group S at 72 h after surgery (P < 0.05). Meanwhile, the dose of sufentanil and PCIA compression in group T were significantly lower than those in group S (P < 0.05), and the incidence of sleep failure was significantly lower than that in group S (P < 0.05). Conclusion Compared with PCIA alone, TPVB combined with PCIA can improve the pain control effect of postoperative laparoscopic liver cancer patients while reducing the use of postoperative opioid analgesics, and can significantly reduce the release of inflammatory factors and pain media, and improve CD4+/CD8+ inversion. |