超声引导星状神经节阻滞有益于腹腔镜结直肠手术患者的术后恢复：一项单中心、双盲、随机对照临床试验。
Ultrasound-guided stellate ganglion block benefits the postoperative recovery of patients undergoing laparoscopic colorectal surgery: a single-center, double-blinded, randomized controlled clinical trial.
机构信息
Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58 2nd Zhongshan Road, Guangzhou, Guangdong, 510080, P.R. China.
Department of Hepatobiliary Surgery, The Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No. 107 Yanjiang West Road, Guangzhou, Guangdong, 510120, P.R. China.
出版信息
BMC Anesthesiol. 2024 Apr 10;24(1):137. doi: 10.1186/s12871-024-02518-5.
BACKGROUND
With the increasing prevalence of colorectal cancer (CRC), optimizing perioperative management is of paramount importance. This study investigates the potential of stellate ganglion block (SGB), known for its stress response-mediating effects, in improving postoperative recovery. We postulate that preoperative SGB may enhance the postoperative recovery of patients undergoing laparoscopic CRC surgery.
METHODS
We conducted a randomized controlled trial of 57 patients undergoing laparoscopic colorectal cancer surgery at a single center. Patients, aged 18-70 years, were randomly assigned to receive either preoperative SGB or standard care. SGB group patients received 10 mL of 0.2% ropivacaine under ultrasound guidance prior to surgery. Primary outcome was time to flatus, with secondary outcomes encompassing time to defecation, lying in bed time, visual analog scale (VAS) pain score, hospital stays, patient costs, intraoperative and postoperative complications, and 3-year mortality. A per-protocol analysis was used.
RESULTS
Twenty-nine patients in the SGB group and 28 patients in the control group were analyzed. The SGB group exhibited a significantly shorter time to flatus (mean [SD] hour, 20.52 [9.18] vs. 27.93 [11.69]; p = 0.012), accompanied by decreased plasma cortisol levels (mean [SD], postoperatively, 4.01 [3.42] vs 7.75 [3.13], p = 0.02). Notably, postoperative pain was effectively managed, evident by lower VAS scores at 6 h post-surgery in SGB-treated patients (mean [SD], 4.70 [0.91] vs 5.35 [1.32]; p = 0.040). Furthermore, patients in the SGB group experienced reduced hospital stay length (mean [SD], day, 6.61 [1.57] vs 8.72 [5.13], p = 0.042).
CONCLUSIONS
Preoperative SGB emerges as a promising approach to enhance the postoperative recovery of patients undergoing laparoscopic CRC surgery.
CLINICAL TRIAL REGISTRATION
ChiCTR1900028404, Principal investigator: Xia Feng, Date of registration: 12/20/2019.
背景
随着结直肠癌（CRC）发病率的增加，优化围手术期管理至关重要。本研究探讨了星状神经节阻滞（SGB）在改善术后恢复方面的潜力，SGB 以其对应激反应的调节作用而闻名。我们推测术前 SGB 可能会促进接受腹腔镜 CRC 手术的患者的术后恢复。
方法
我们在一家中心进行了一项随机对照试验，共纳入 57 例接受腹腔镜结直肠手术的患者。患者年龄 18-70 岁，随机分为 SGB 组或对照组。SGB 组在手术前超声引导下接受 10ml0.2%罗哌卡因。主要结果是肛门排气时间，次要结果包括排便时间、卧床时间、视觉模拟评分（VAS）疼痛评分、住院时间、患者费用、术中及术后并发症和 3 年死亡率。采用意向性分析。
结果
SGB 组 29 例，对照组 28 例。SGB 组肛门排气时间明显缩短（平均[标准差]小时，20.52[9.18]vs.27.93[11.69]；p=0.012），术后血浆皮质醇水平降低（平均[标准差]，术后，4.01[3.42]vs7.75[3.13]，p=0.02）。值得注意的是，SGB 组术后疼痛得到有效控制，术后 6 小时 VAS 评分较低（平均[标准差]，4.70[0.91]vs5.35[1.32]；p=0.040）。此外，SGB 组患者的住院时间较短（平均[标准差]，天，6.61[1.57]vs8.72[5.13]，p=0.042）。
结论
术前 SGB 有望促进腹腔镜 CRC 手术患者的术后恢复。
临床试验注册
ChiCTR1900028404，主要研究者：夏峰，注册日期：2019 年 12 月 20 日。
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