Bao Yin, Xiong Jun, Wang Huijun, Zhang Yang, Zhong Qi, Wang Guyan
Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Department of Anesthesiology, Shenzhen University General Hospital, Shenzhen University, Shenzhen, China.
Front Surg. 2022 Feb 15;9:829811. doi: 10.3389/fsurg.2022.829811. eCollection 2022.
Suspension laryngoscopy is commonly used in operative laryngology. Although it is efficient and minimally invasive in most cases, it can lead to postoperative sore throat (POST) and cough. Because of intensive stimulation by the rigid metal suspension laryngoscope, procedures must be implemented under general anesthesia. Together, these factors increase the possibility of postoperative complications. Blocking the internal branch of the superior laryngeal nerve (SLN) is useful in inhibiting the endotracheal intubation stress response. Thus, we evaluated the efficacy of ultrasound-guided block of the internal branches of the superior laryngeal nerve to improve postoperative complications.
A total of 64 patients was scheduled for elective laryngeal cancer resection, and suspension laryngoscopic surgery was performed under general anesthesia with a block of the internal branch of the superior laryngeal nerve (group iSLNB, = 32) and without a block (group C, = 32). Patients in group iSLNB received ultrasound-guided blocks of the internal branches of superior laryngeal nerve bilaterally (0.2% ropivacaine, 2 ml each side). The primary outcome measures were the incidence and severity of sore throat and cough assessed 0.5, 2, 6, and 24 h after tracheal extubation. The secondary outcome measures were heart rate and mean arterial pressure on arrival in the operating room (T0), at endotracheal intubation (T1), upon insertion of the suspension laryngoscope (T2), 5 min after insertion (T3), at tracheal extubation (T4), and 5 min after extubation (T5). Blood glucose levels were measured at T0, T3, and T5.
The incidence and severity of POST and cough in the iSLNB (internal branch of superior laryngeal nerve block) group were significantly reduced within 6 h after extubation compared with those in the control group, regardless of whether swallowing was present ( < 0.05). Compared to the control group from T0-T5, except at T0, the iSLNB group had significantly lower heart rate and mean arterial pressure ( < 0.05). Compared to T0, at other time points, the heart rates in the control group were significantly increased ( < 0.05), and the mean arterial pressures at other time points in the iSLNB group were significantly lower than those at T0 ( < 0.05). The blood glucose levels at T3 and T5 in the iSLNB group were significantly reduced compared with those in the control group ( < 0.05).
Ultrasound-guided block of the internal branch of the superior laryngeal nerve might effectively ameliorate postoperative complications secondary to suspension laryngoscopic surgery with endotracheal intubation under general anesthesia and improve hemodynamic stability.
https://www.chictr.org.cn, identifier: ChiCTR2100049801.
悬吊喉镜检查常用于喉科手术。尽管在大多数情况下它高效且微创，但可能导致术后咽痛（POST）和咳嗽。由于硬质金属悬吊喉镜的强烈刺激，手术必须在全身麻醉下进行。这些因素共同增加了术后并发症的可能性。阻滞喉上神经（SLN）内支有助于抑制气管插管应激反应。因此，我们评估了超声引导下喉上神经内支阻滞对改善术后并发症的疗效。
共有64例计划行择期喉癌切除术的患者，在全身麻醉下接受悬吊喉镜手术，其中一组行喉上神经内支阻滞（iSLNB组，n = 32），另一组不行阻滞（C组，n = 32）。iSLNB组患者接受双侧超声引导下喉上神经内支阻滞（0.2%罗哌卡因，每侧2 ml）。主要观察指标为气管拔管后0.5、2、6和24小时评估的咽痛和咳嗽的发生率及严重程度。次要观察指标为进入手术室时（T0）、气管插管时（T1）、插入悬吊喉镜时（T2）、插入后5分钟（T3）、气管拔管时（T4）和拔管后5分钟（T5）的心率和平均动脉压。在T0、T3和T5测量血糖水平。
与对照组相比，iSLNB（喉上神经内支阻滞）组拔管后6小时内POST和咳嗽的发生率及严重程度均显著降低，无论是否存在吞咽情况（P < 0.05）。与对照组从T0到T5相比，除T0外，iSLNB组的心率和平均动脉压显著更低（P < 0.05）。与T0相比，在其他时间点，对照组的心率显著升高（P < 0.05），iSLNB组其他时间点的平均动脉压显著低于T0时（P < 0.05）。与对照组相比，iSLNB组在T3和T5时的血糖水平显著降低（P < 0.05）。
超声引导下喉上神经内支阻滞可能有效改善全身麻醉下行气管插管的悬吊喉镜手术后的并发症，并改善血流动力学稳定性。
