Abstract:Objective To explore the efficacy and safety of paravertebral block in thoracoscopic pulmonary lobectomy with low concentration bupivacaine combined with dexamethasone in patients with lung cancer. Methods A retrospective analysis was performed in 90 ASA ( American Society of Anesthesiologists) Ⅰ and Ⅱ patients scheduled for thoracoscopic lobectomy in the Jinling Hospital from November 2017 to January 2019.The patients were divided into group A,group B and group C according to different postoperative analgesia methods(n=30,each).Before chest closure,a loading dose of 0.13% bupivacaine 15 ml was injected and followed by 0.13% bupivacaine analgesia pump for continuous postoperative analgesia in group A.A loading dose of 15 ml bupivacaine (0.13%) and dexamethasone mixture was given and maintained by analgesia pump for continuous postoperative analgesia in group B.Patient-controlled intravenous analgesia(PCIA) was conducted in group C.At 6-(T₁),12-(T₂),24-(T₃),48-(T₄) and 72-h(T₅) after operation,the degree of pain at rest and on activity by visual analogue scale (VAS),the incidence of complications,the number of patients needing additional analgesics and prognostic indexes were observed. Results VAS scores in group B were significantly lower than those in group A at T₁ and T₃(P<0.05),VAS scores in group B were significantly lower than those in group C at T₁ and T₅(P<0.05),and VAS score in group A was significantly lower than that in group C at T₅ (P<0.05).VAS scores in group B were significantly lower than those in group A at T₁,T₂,T₃ and T₅(P<0.05)and were significantly lower than those in group C at T₁ and T₅,and VAS score in group A was significantly lower than that in group C at T₅(all P<0.05).There was no significant difference in postoperative utilization rate of pethidine among three groups (P>0.05).The total incidence of postoperative nausea,vomiting,sleepiness and other complications in group A and group B was 6.67% and 0 respectively,and 53.33% in group C,the difference between the three groups was statistically significant (P<0.01).There were no local anesthetic poisoning,hemopneumothorax and pulmonary complications in group A and B. Compared with group C,the first time out -of- bed,the drainage tube indwelling time and the length of hospital stay significantly shortened in group A and B (P<0.05),however,there were no statistically differences in them between group A and group B (P>0.05). Conclusion For lung cancer patients undergoing thoracoscopic lobectomy,paravertebral block with low concentration bupivacaine or low concentration bupivacaine combined with dexamethasone are safe and effective.Compared with intravenous analgesia,0.13% bupivacaine combined with dexamethasone has better analgesic effect and fewer complications,which can accelerate postoperative rehabilitation.