To Investigate the Effects of Combined Use of Naldebain® ER Injection and Precedex® After Video-assisted Thoracoscopic Surgery

Ⅰ.Protocol title: To investigate the effects of combined use of Naldebain® ER Injection and Precedex® after video-assisted thoracoscopic surgery

Ⅱ.Objectives: Video-assisted thoracoscopic surgery (VATS) is currently the mainstream of thoracic surgery, but it may also cause stronger postoperative pain than expected. Therefore, pain control after thoracoscopic surgery is very important, because increased acute pain will increase the incidence of chronic pain, and untreated pain may lead to increased postoperative complications. At present, the combined use of regional nerve block, opioids, and non-steroidal anti-inflammatory drugs is the current mainstream strategy for multimodal analgesia after thoracoscopic surgery.

Paravertebral block (PVB) involves injecting a local anesthetic into the paravertebral wedge-shaped space as it emerges from the intervertebral foramen. It produces an ipsilateral somatosensory and sympathetic block, and has good analgesic effects on anesthesia and unilaterally induced pain from the chest and abdomen. So far, thoracic paravertebral block (TPVB) is considered the best alternative to thoracic epidural analgesia because it can provide effective immediate postoperative analgesic effect in patients undergoing VATS.

Naldebain® ER Injection is a long-acting prodrug of Nalbuphine, aimed at addressing the medical need for long-acting analgesics. It is an agonist-antagonist of synthetic phenanthrene series opioids. It is chemically related to the widely used opioid antagonist naloxone and the potent opioid pain reliever oxymorphone. At present, nalbuphine sebacate has been used in many surgical procedures to relieve postoperative pain.

Precedex® injection (dexmedetomidine hydrochloride), a centrally acting α2-receptor agonist, has the same sedative effects as other benzodiazepine drugs. However, due to the different pharmacological mechanisms, there are no side effects such as respiratory depression and delirium. In addition, according to Venn et al. in 2000, when 33 postoperative patients were using respirators in the intensive care unit, they found that the use of dexmedetomidine could reduce the use of morphine by 50%, thereby reducing the possible side effects of opioids and as a good adjuvant drug for pain relief.