术后疼痛管理和认知功能保留对于接受胸腔镜肺癌手术的患者至关重要。这是通过使用基于胸椎旁阻滞 (TPVB) 或舒芬太尼 (SUF) 的多模式镇痛来实现的。但两者联合使用对术后疼痛和术后认知功能障碍(POCD)的疗效及影响尚不清楚。 探讨TPVB联合SUF为基础的多模式镇痛对胸腔镜LC根治术患者的镇痛效果及对POCD的影响帮助优化术后疼痛管理并改善患者预后。本回顾性分析包括 2021 年 5 月至 2023 年 1 月期间在郑州大学附属肿瘤医院和河南省肿瘤医院接受胸腔镜 LC 根治术的 107 例患者。 n = 50) 和接受基于 TPVB SUF 的多模式镇痛的患者 (n = 57) 分别被分配到对照组和 TPVB 组。我们比较了术后 2、12 和 24 小时两组之间静息和咳嗽时的拉姆齐镇静量表和视觉模拟量表 (VAS) 评分。肾上腺素（E）、血管紧张素II（Ang II）、去甲肾上腺素（NE）、超氧化物歧化酶（SOD）、血管内皮生长因子（VEGF）、转化生长因子-β1（TGF-β1）、肿瘤坏死因子的血清水平术前和术后24小时测量-α（TNF-α）和S-100钙结合蛋白β（S-100β）。术前1天、术后3天、5天进行简易精神状态检查（MMSE），术后5天监测POCD的发生情况。记录不良反应。两组Ramsay镇静评分的时间点、组间及交互作用均无显着性（P > 0.05）。值得注意的是，静息时和咳嗽时的 VAS 评分均存在显着的时间点效应、组间差异和交互效应（P < 0.05）。术后12、24 h静息及咳嗽时VAS评分均低于术后2 h，且随术后时间延长逐渐降低（P < 0.05）。 TPVB组术后2、12、24 h VAS评分低于对照组（P < 0.05）。 TPVB组术后第1、3天MMSE评分显着高于对照组（P < 0.05）。术后5 d内TPVB组POCD发生率显着低于对照组（P < 0.05）。术后 24 h 两组患者血清 E、Ang II、NE 均较术前升高，血清 SOD 水平较术前降低，其中 TPVB 组各项指标优于术前（P < 0.05）。术后24 h,两组血清VEGF、TGF-β1、TNF-α、S-100β水平均明显升高,其中TPVB组低于对照组(P < 0.05)。联合基于SUF的多模式镇痛进一步缓解胸腔镜LC根治手术患者的疼痛，增强镇痛效果，减轻术后应激反应，抑制术后血清VEGF、TGF-β1、TNF-α、S-100β水平的升高。该方案还降低了 POCD，安全性较高。©作者 2024。百事登出版集团出版。保留所有权利。

Postoperative pain management and cognitive function preservation are crucial for patients undergoing thoracoscopic surgery for lung cancer (LC). This is achieved using either a thoracic paravertebral block (TPVB) or sufentanil (SUF)-based multimodal analgesia. However, the efficacy and impact of their combined use on postoperative pain and postoperative cognitive dysfunction (POCD) remain unclear.To explore the analgesic effect and the influence on POCD of TPVB combined with SUF-based multimodal analgesia in patients undergoing thoracoscopic radical resection for LC to help optimize postoperative pain management and improve patient outcomes.This retrospective analysis included 107 patients undergoing thoracoscopic radical resection for LC at The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital between May 2021 and January 2023. Patients receiving SUF-based multimodal analgesia (n = 50) and patients receiving TPVB + SUF-based multimodal analgesia (n = 57) were assigned to the control group and TPVB group, respectively. We compared the Ramsay Sedation Scale and visual analog scale (VAS) scores at rest and with cough between the two groups at 2, 12, and 24 h after surgery. Serum levels of epinephrine (E), angio-tensin II (Ang II), norepinephrine (NE), superoxide dismutase (SOD), vascular endothelial growth factor (VEGF), transforming growth factor-β1 (TGF-β1), tumor necrosis factor-α (TNF-α), and S-100 calcium-binding protein β (S-100β) were measured before and 24 h after surgery. The Mini-Mental State Examination (MMSE) was administered 1 day before surgery and at 3 and 5 days after surgery, and the occurrence of POCD was monitored for 5 days after surgery. Adverse reactions were also recorded.There were no significant time point, between-group, and interaction effects in Ramsay sedation scores between the two groups (P > 0.05). Significantly, there were notable time point effects, between-group differences, and interaction effects observed in VAS scores both at rest and with cough (P < 0.05). The VAS scores at rest and with cough at 12 and 24 h after surgery were lower than those at 2 h after surgery and gradually decreased as postoperative time increased (P < 0.05). The TPVB group had lower VAS scores than the control group at 2, 12, and 24 h after surgery (P < 0.05). The MMSE scores at postoperative days 1 and 3 were markedly higher in the TPVB group than in the control group (P < 0.05). The incidence of POCD was significantly lower in the TPVB group than in the control group within 5 days after surgery (P < 0.05). Both groups had elevated serum E, Ang II, and NE and decreased serum SOD levels at 24 h after surgery compared with the preoperative levels, with better indices in the TPVB group (P < 0.05). Marked elevations in serum levels of VEGF, TGF-β1, TNF-α, and S-100β were observed in both groups at 24 h after surgery, with lower levels in the TPVB group than in the control group (P < 0.05).TPVB combined with SUF-based multimodal analgesia further relieves pain in patients undergoing thoracoscopic radical surgery for LC, enhances analgesic effects, reduces postoperative stress response, and inhibits postoperative increases in serum VEGF, TGF-β1, TNF-α, and S-100β levels. This scheme also reduced POCD and had a high safety profile.©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.