Evaluation of the effect of serratus anterior combined with transversus abdominis plane block in the radical operation of esophageal cancer guided by ultrasound / 中国医师进修杂志

ABSTRACT

Objective:To evaluate the effect of general anesthesia combined with ultrasound-guided serratus anterior plane block and transversus abdominis plane block of the lower costal margin in minimally invasive radical resection of esophageal cancer.Methods:Forty patients who underwent thoracolaparoscopic minimally invasive radical esophageal cancer radical resection in the Yuying Children′s Hospital, the Second Affiliated Hospital of Wenzhou Medical University from April to June 2020 were selected. According to the random number table, they were divided into nerve block group and control group, with 20 cases in each group. The general anesthesia was the same in the two groups. The nerve block group was blocked at the serratus anterior plane and the bilateral transversus abdominis plane after the induction of general anesthesia. The intraoperative dosages of propofol, remifentanil, and sufentanil were compared between the two groups. The postoperative extubation time, the time of stay in the postanesthesia care unit (PACU), and the postoperative hospital stay were compared between the two groups. The visual analogue scale (VAS) scores under static and coughing conditions 30 min, 2 h, 4 h, 12 h and 24 h after surgery, and the 24 h postoperative intravenous patient-controlled intravenous analgesia (PCIA) drug dosage and the occurrence of nausea and vomiting were compared between the two groups.Results:The intraoperative dosages of propofol, remifentanil and sufentanil in the nerve block group were lower than those in the control group (1 262.6 ± 163.8) mg vs. (1 388.3 ± 213.2) mg, (3 834.3 ± 477.3) mg vs. (4 175.2 ± 503.4) mg, (56.3 ± 8.2) mg vs. (66.1 ± 5.3) mg, and the differences were statistically significant ( P<0.05). The postoperative extubation time, PACU stay time and postoperative hospital stay in the nerve block group were significantly shorter than those in the control group (28.6 ± 12.1) h vs. (42.1 ± 13.7) h, (66.8 ± 21.4) h vs. (89.3 ± 35.4) h, (10.4 ± 2.0) d vs. (14.5 ± 7.0) d, and the differences were statistically significant ( P<0.05). The VAS scores of patients in the nerve block group were lower than those in the control group under static and coughing conditions at 30 min and 2, 4, 12, 24 h after the operation, and the differences were statistically significant ( P<0.05). The ratio of total PCIA compressions/effective compressions within 48 h after the operation of the nerve block group and the total amount of analgesic pump drug infusion at 24 and 48 h after the operation were lower than those in the control group 1.21 ± 0.19 vs. 1.42 ± 0.20, (39.3 ± 3.2) ml vs. (106.5 ± 7.4) ml, (138.5 ± 9.5) ml vs. (211.9 ± 13.7) ml, and the differences were statistically significant ( P<0.05). The incidence of postoperative nausea and vomiting in the nerve block group were lower than those in the control group 25.0% (5/20) vs. 65.0% (13/20), 10.0% (2/20) vs. 45.0% (9/20), and the differences were statistically significant ( P<0.05). Conclusions:General anesthesia combined with ultrasound-guided serratus anterior plane block and transversus abdominis plane block can reduce the amount of anesthetics and opioid analgesics in minimally invasive radical resection of esophageal cancer, improve the patient′s recovery quality, enhance the operation post-analgesic effect, and accelerate the patient′s recovery.