Geng Jun, Wang Jing, Zhang Yaowen, Song Wenxiang, Zhu Junjia, Chen Jianqing, Wu Zhen
Department of Anesthesiology, Jiangyin Hospital Affiliated to Southeast University Medical School, Wuxi, 214400 Jiangsu, China.
Department of General Surgery, Jiangyin Hospital Affiliated to Southeast University Medical School, Wuxi, 214400 Jiangsu, China.
Int J Breast Cancer. 2022 Jun 6;2022:3359130. doi: 10.1155/2022/3359130. eCollection 2022.
Regional anaesthesia reports to attenuate stress and inflammatory responses associated with surgical resection; however, the effectiveness of combined nerve blocks is less often investigated. We evaluated whether a combination of a pectoral nerve block (PNB) and stellate ganglion block (SGB) is more effective than a PNB alone in reducing these responses in women undergoing modified radical mastectomy (MRM).
This is a prospective randomized controlled trial. Fifty patients with breast cancer were randomly allocated to receive an ultrasound-guided PNB ( = 25, PNB only group) or ultrasound-guided PNB combined with SGB ( = 25, combined blockade group). The primary outcome was perioperative plasma level of interleukin- (IL-) 6. Secondary outcomes included perioperative plasma levels of cortisol, glucose, IL-8, and tumour necrosis factor- (TNF-) , pain scores, haemodynamic variables, sleep quality, and complications postsurgery.
The combined blockade group exhibited significantly lower IL-6 and TNF- levels 24 h postsurgery. Cortisol levels were significantly lower in the combined blockade group at the end of the surgery. Glucose levels at the time of incision were lower in the combined blockade group. Pain scores up to 12 h postsurgery were significantly lower in the combined blockade group, which also exhibited better perioperative haemodynamic stability. Patients in the combined blockade group reported better sleep quality on the night of surgery.
In patients undergoing MRM, PNB combined with SGB block effectively blunted perioperative inflammatory response than PNB alone. A combined block approach can also alleviate stress response and postoperative acute pain with stable perioperative haemodynamics and better postoperative sleep quality.
区域麻醉据报道可减轻与手术切除相关的应激和炎症反应；然而，联合神经阻滞的有效性较少被研究。我们评估了在接受改良根治性乳房切除术（MRM）的女性中，胸段神经阻滞（PNB）联合星状神经节阻滞（SGB）在减轻这些反应方面是否比单纯PNB更有效。
这是一项前瞻性随机对照试验。50例乳腺癌患者被随机分配接受超声引导下的PNB（n = 25，单纯PNB组）或超声引导下的PNB联合SGB（n = 25，联合阻滞组）。主要结局是围手术期血浆白细胞介素-6（IL-6）水平。次要结局包括围手术期血浆皮质醇、葡萄糖、IL-8和肿瘤坏死因子-α（TNF-α）水平、疼痛评分、血流动力学变量、睡眠质量和术后并发症。
联合阻滞组术后24小时IL-6和TNF-α水平显著降低。手术结束时联合阻滞组皮质醇水平显著降低。联合阻滞组切口时的葡萄糖水平较低。联合阻滞组术后12小时内的疼痛评分显著较低，且围手术期血流动力学稳定性更好。联合阻滞组患者在手术当晚报告睡眠质量更好。
在接受MRM的患者中，PNB联合SGB阻滞比单纯PNB更有效地减轻围手术期炎症反应。联合阻滞方法还可缓解应激反应和术后急性疼痛，围手术期血流动力学稳定，术后睡眠质量更好。
