Lei Weiping, Cheng Jiating, Bignami Elena, Gonzalez Michel, Sun Qirui, Sun Jianliang, Cheng Yuan
Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, China.
Department of Anesthesiology, The Second Affiliated Clinical College of Wenzhou Medical University, Wenzhou, China.
J Thorac Dis. 2025 May 30;17(5):3238-3248. doi: 10.21037/jtd-2025-726. Epub 2025 May 21.
Perioperative stress response is an important risk factor for perioperative neurocognitive disorder (PND) in elderly patients. This study aimed to evaluate and compare the effects of a modified deep serratus anterior plane block (DSPB) combined with general anesthesia on surgical stress and PND in elderly patients undergoing thoracic surgery.
A total of 66 patients undergoing thoracic surgery were randomly assigned to receive either a single-shot DSPB or local block after tracheal intubation using ropivacaine 0.5% (20 mL). The primary outcomes were the visual analog scale (VAS) scores at each time point. The secondary outcomes included the Montreal Cognitive Assessment (MoCA) score before surgery and after discharge from the hospital (or seventh day postoperatively), malondialdehyde (MDA), superoxide dismutase (SOD), and serum cortisol levels, drug consumption, vital signs, and blood gas analysis.
Ultimately, 60 patients were enrolled in the study. The VAS scores were significantly lower in the DSPB group than the local block group (all P<0.05). There was a statistically significant difference in the blood gas analysis index total carbon dioxide (TCO) content (27.71±3.49 29.31±2.26 mmHg) between the two groups (P<0.05). The length of hospitalization was shorter in the DSPB group than the local block group (6.03±1.35 7.20±1.49 days), and the difference was statistically significant (P<0.05). There were no statistically significant differences between the two groups in terms of the MoCA scores before surgery and after hospitalization (or the seventh day postoperatively), stress indices, vital signs, bispectral index (BIS) value, blood gas analysis (except TCO), and drug use during extubation at each time point (all P>0.05).
Compared with the local block, the elderly patients undergoing thoracic surgery who received the DSPB had a superior analgesic effect, a lower VAS score, and shorter length of hospitalization. As a DSPB does not require ultrasound equipment, it is simpler and easier to operate than a local block, and is especially suitable for widespread implementation in small hospitals.
China Clinical Trials Registry ChiCTR2300068717.
围手术期应激反应是老年患者围手术期神经认知障碍（PND）的重要危险因素。本研究旨在评估和比较改良的前锯肌平面阻滞（DSPB）联合全身麻醉对老年胸科手术患者手术应激和PND的影响。
总共66例接受胸科手术的患者被随机分配，分别在气管插管后接受单次DSPB或使用0.5%罗哌卡因（20 mL）进行局部阻滞。主要结局指标是各时间点的视觉模拟评分（VAS）。次要结局指标包括术前、出院后（或术后第7天）的蒙特利尔认知评估（MoCA）评分、丙二醛（MDA）、超氧化物歧化酶（SOD）和血清皮质醇水平、药物消耗量、生命体征及血气分析。
最终，60例患者纳入研究。DSPB组的VAS评分显著低于局部阻滞组（所有P<0.05）。两组间血气分析指标总二氧化碳（TCO）含量（27.71±3.49 29.31±2.26 mmHg）存在统计学差异（P<0.05）。DSPB组的住院时间短于局部阻滞组（6.03±1.35 7.20±1.49天），差异具有统计学意义（P<0.05）。两组在术前及住院后（或术后第7天）的MoCA评分、应激指标、生命体征、脑电双频指数（BIS）值、血气分析（除TCO外）以及各时间点拔管时的药物使用情况方面均无统计学差异（所有P>0.05）。
与局部阻滞相比，接受DSPB的老年胸科手术患者镇痛效果更佳，VAS评分更低，住院时间更短。由于DSPB不需要超声设备，其操作比局部阻滞更简单、更容易，尤其适合在小医院广泛开展。
中国临床试验注册中心ChiCTR2300068717
