RESUMO
BACKGROUND: Postoperative pulmonary complications (PPCs) extend the length of stay of patients and increase the perioperative mortality rate after video-assisted thoracoscopic (VATS) pulmonary surgery. Thoracic paravertebral block (TPVB) provides effective analgesia after VATS surgery; however, little is known about the effect of TPVB on the incidence of PPCs. The aim of this study is to determine whether TPVB combined with GA causes fewer PPCs and provides better perioperative lung protection in patients undergoing VATS pulmonary surgery than simple general anaesthesia. METHODS: A total of 302 patients undergoing VATS pulmonary surgery will be randomly divided into two groups: the paravertebral block group (PV group) and the control group (C group). Patients in the PV group will receive TPVB: 15 ml of 0.5% ropivacaine will be administered to the T4 and T7 thoracic paravertebral spaces before general anaesthesia induction. Patients in the C group will not undergo the intervention. Both groups of patients will be subjected to a protective ventilation strategy during the operation. Perioperative protective mechanical ventilation and standard fluid management will be applied in both groups. Patient-controlled intravenous analgesia is used for postoperative analgesia. The primary endpoint is a composite outcome of PPCs within 7 days after surgery. Secondary endpoints include blood gas analysis, postoperative lung ultrasound score, NRS score, QoR-15 score, hospitalization-related indicators and long-term prognosis indicators. DISCUSSION: This study will better evaluate the impact of TPVB on the incidence of PPCs and the long-term prognosis in patients undergoing VATS lobectomy/segmentectomy. The results may provide clinical evidence for optimizing perioperative lung protection strategies. TRIAL REGISTRATION: ClinicalTrials.gov NCT05922449 . Registered on June 25, 2023.
Assuntos
Bloqueio Nervoso , Cirurgia Torácica Vídeoassistida , Humanos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Bloqueio Nervoso/efeitos adversos , Respiração , Analgesia Controlada pelo Paciente , Pulmão/cirurgia , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Bupivacaine has previously been reported to induce neurotoxicity, which is further enhanced by high glucose levels. In the present study, the underlying molecular mechanisms via which bupivacaine induces cytotoxicity under high glucose conditions were investigated in cultured human SHSY5Y cells. In order to identify the optimal concentrations of glucose and bupivacaine that induced cytotoxicity, SHSY5Y cells were treated with 30100 mM glucose and 0.51.0 mM bupivacaine. Based on the dose response experiments, 50 mM glucose and 0.5 mM bupivacaine was used in the present study. The effects that 3MA (autophagy inhibitor) and rapamycin (RAPA; autophagy inducer) exerted on cell apoptosis, autophagy and the expression of protein kinase Rlike endoplasmic reticulum kinase (PERK)activating transcription factor 4 (ATF4)C/EBPhomologous protein (CHOP) and inositolrequiring enzyme 1 (IRE1)tumor necrosis factor receptor associated factor 2 (TRAF2) signaling proteins were measured in high glucose and bupivacainetreated cells. Cell viability was measured using a Cell Counting Kit8 assay, cell apoptosis was assessed using flow cytometry, and protein expression was determined using western blot analyses. Compared with the control group, high glucose and bupivacaine significantly increased ATF4, CHOP and caspase12 expression, increased apoptosis, and decreased pIRE1, TRAF2, LC3II/LC3I and Beclin1 expression. Promoting autophagy with RAPA partly reversed the high glucose and bupivacaineinduced changes in pPERK, CHOP, TRAF2, Beclin1, caspase12 and apoptosis, while inhibiting autophagy with 3MA further enhanced the changes in ATF4, CHOP, pIRE1, TRAF2 and apoptosis. High glucose and bupivacaine induced cytotoxicity in SHSY5Y cells, at least in part, through enhancing cell apoptosis and inhibiting autophagy via the PERKATF4CHOP and IRE1TRAF2 signaling pathways.