Optimization strategy of anesthesia for liver cancer resection: serratus anterior plane block-posterior rectus sheath block-general anesthesia
10.3760/cma.j.cn131073.20211028.00105
- VernacularTitle:肝癌切除术麻醉的优化策略：前锯肌平面阻滞-腹直肌后鞘阻滞-全身麻醉
- Author:
Congcong LI
1
;
Yitian YANG
;
Na LI
;
Mengyan HAN
;
Wei ZHANG
;
Jiaqiang ZHANG
Author Information
1. 河南省人民医院麻醉与围术期医学科，郑州 450003
- Keywords:
Lung neoplasms;
Nerve block;
Rectus abdominis;
Serratus anterior
- From:
Chinese Journal of Anesthesiology
2022;42(1):24-28
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the optimization strategy of anesthesia for liver cancer resection using serratus anterior plane block-posterior rectus sheath block-general anesthesia.Methods:One hundred patients, aged 30-64 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with liver function Child-Pugh grade A or B, scheduled for elective liver cancer resection under general anesthesia, were divided into serratus anterior plane block combined with posterior rectus sheath block group (group S, n=50) and thoracic paravertebral block group (group T, n=50) using a random number table method.Ultrasound-guided serratus anterior plane block (20 ml) combined with posterior rectus sheath block (10 ml) was performed using 0.375% ropivacaine in group S. Ultrasound-guided paravertebral block was performed at T 7 and T 9(15 ml for each site) with 0.375% ropivacaine in group T. Anesthesia was induced with intravenous midazolam, propofol, sufentanil and cisatracurium and maintained with intravenous infusion of propofol and remifentanil and intermittent intravenous boluses of cisatracurium.BIS value was maintained at 40-60 during operation.Patient-controlled intravenous analgesia (PCIA) was performed with sufentanil and flurbiprofen at the end of operation, and oxycodone 5 mg was intravenously injected as rescue analgesic when the VAS score>3.The onset time and operation time of nerve block were recorded.The intraoperative consumption of sufentanil and remifentanil and occurrence of cardiovascular events within 30 min after skin incision were recorded.The effective pressing times of PCA and requirement for rescue analgesia within 48 h after operation were recorded.The recovery quality was measured using the 40-item quality of recovery questionnaire at 24 h before surgery and 24 and 48 h after surgery.Peripheral venous blood samples were collected at 24 h before surgery and 24 h and 7 days after surgery to determine the concentrations of interleukin-17 and interferon-gamma in serum.The postoperative time to first flatus, first ambulation time, and length of hospital stay were recorded.The nausea and vomiting, respiratory depression, skin itching, puncture site infection, pneumothorax and other adverse reactions were recorded within 48 h after operation. Results:Compared with group T, the operation time of nerve block was significantly shortened, the incidence of intraoperative hypotension was decreased ( P<0.05), and no significant change was found in the onset time of nerve block, intraoperative consumption of sufentanil and remifentanil, postoperative requirement for rescue analgesia, effective pressing times of PCA, time to first flatus, first ambulation time, and length of hospital stay, and 40-item quality of recovery scores and serum concentrations of interleukin-17 and interferon-gamma at each time point in group S ( P>0.05). No postoperative adverse reactions were found in either group. Conclusions:Compared with thoracic paravertebral nerve block combined with general anesthesia, serratus anterior plane block-posterior rectus sheath block-general anesthesia has shorter operation time and lower incidence of intraoperative hypotension when used for liver cancer resection.
