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
ARTICLE HIGHLIGHTS
Research background

Transarterial chemoembolization (TACE) combined with microwave ablation (MWA) has emerged as an effective treatment strategy for patients with advanced gastric cancer and liver metastasis. However, this approach often leads to severe postoperative pain and inflammatory responses, impacting patient comfort and recovery. The paravertebral block (PVB) is a regional anesthetic technique known for providing analgesia in the thoracic and abdominal regions. This study aims to evaluate the potential benefits of PVB in terms of postoperative analgesia and inflammatory response in patients undergoing TACE combined with MWA for advanced gastric cancer and liver metastasis. By comparing the outcomes between the PVB group and the control group receiving intravenous analgesia, this research investigates the effectiveness of PVB in reducing pain scores, minimizing sufentanil consumption, decreasing adverse events, and lowering inflammatory marker levels. The findings of this study will shed light on the role of PVB in managing pain and inflammation and improving the postoperative experience and recovery of patients with advanced gastric cancer and liver metastasis treated with TACE combined with MWA.

Research motivation

The treatment of advanced gastric cancer and liver metastasis using TACE combined with MWA has shown promising results. However, the occurrence of severe postoperative pain and inflammatory responses poses significant challenges in patient management. The PVB technique offers a potential solution by providing effective analgesia to the thoracic and abdominal regions. This study aims to investigate the impact of PVB on postoperative pain and inflammation in patients undergoing TACE combined with MWA for advanced gastric cancer and liver metastasis.

Research objectives

The main objective of this study was 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. The specific objectives were to compare the visual analog scale (VAS) scores for pain, the dose of sufentanil used, the incidence of adverse events, and the levels of inflammatory markers between the PVB group and the control group. The significance of realizing these objectives is to contribute to improving postoperative comfort and recovery in patients with advanced gastric cancer and liver metastasis treated with TACE combined with MWA, as well as informing future research in this field.

Research methods

This study used a randomized controlled trial design. Sixty patients undergoing TACE combined with MWA for advanced gastric cancer and liver metastasis were randomly divided into two groups: the PVB group and the control group. The PVB group received ultrasound-guided PVB with 0.375% ropivacaine preoperatively, while the control group received intravenous analgesia with sufentanil. The primary outcome measured was the VAS score for pain at specific time points after the procedure. Secondary outcomes included the dose of sufentanil used, incidence of adverse events, and levels of inflammatory markers before and after the procedure. Statistical analyses were performed to compare the outcomes between the two groups.

Research results

The findings of this study demonstrated that patients in the PVB group had significantly lower VAS scores for pain at 6 h, 12 h, 24 h, and 48 h after the procedure compared to the control group. Additionally, the PVB group showed reduced consumption of sufentanil and a lower incidence of adverse events such as nausea, vomiting, and respiratory depression. Moreover, the PVB group exhibited significantly lower levels of inflammatory markers 24 h and 48 h after the procedure. These results contribute to the understanding of how PVB can effectively alleviate postoperative pain, reduce inflammatory responses, and enhance the comfort and recovery of patients with advanced gastric cancer and liver metastasis treated with TACE combined with MWA. Further research is needed to address any remaining challenges in optimizing the application of PVB in this context.

Research conclusions

That the use of PVB in patients undergoing TACE combined with MWA for advanced gastric cancer and liver metastasis results in effective reduction of postoperative pain and inflammatory responses. Moreover, PVB improves postoperative comfort and enhances recovery. These results support the implementation of PVB as a valuable technique in managing pain and inflammation in this patient population. Further investigations should focus on optimizing the utilization of PVB and exploring its long-term effects on patient outcomes.

Research perspectives

TACE combined with MWA offers promising research prospects for the treatment of advanced cancer and liver metastasis. Further studies can focus on optimizing the technique and dosage of PVB, exploring its long-term impact on patient prognosis, and investigating the potential synergistic benefits when PVB is combined with other analgesic strategies. Additionally, research can investigate the effects of PVB on other aspects such as quality of life, length of hospital stay, and healthcare costs to further evaluate its overall clinical benefits.