Ultrasound-guided Stellate Ganglion Block Improves The Postoperative Quality Of Recovery After Thyroid Surgery

Objective: We perform preoperative ultrasound-guided right stellate ganglion(SGB)for the patients scheduled for elective thyroid surgery to explore wheather the intervention measure could reduce varieties of postoperative complications,and be one effective method to improve the quality of recovery after thyroid surgery.Methods: Seventy patients were included into study,who aged 18 to 60 years,with ASA classification grade I or II scheduled for elective thyroid surgery.The patients were divided into two groups by randomizing method,each group has 35 cases.The ultrasound-guided right SGB was performed probe 30 minutes before the induction of anesthesia.Group S(SGB group)was perform with 0.2% ropivacaine 4 ml and group C(control group)injected saline 4ml in the same site under ultrasound guidance.The primary outcome was the postoperative quality of recovery assessed by QoR-40.The secondary outcomes: 1.HR and MBP were measured before SGB(T0),15 min after SGB(T1),immediately before tracheal intubation(T2),immediately after tracheal intubation(T3),at the end of surgery procedure(T4),on the instance of tracheal extubation(T5)and 30 min after tracheal extubation(T6).2.The incidence and severity of bucking during extubation period and Ramsay scores at T5 and T6 were recorded.3.Postoperative incision pain scores assessed using VAS at 0.5 h,2 h,8 h,24 h after the surgery,and the times of pressing PCIA and opioid comsumption at 24 h after the surgery were recorded.4.The observer recorded the incidence of POST,headache,PONV,respiratory depression on postoperative 24 h.Results: There has no significant difference on QoR-40 scores before surgery between two groups(P>0.05).The QoR-40 total scores and the socres of the physical comfort,emotional state and pain in group S were significantly higer than group C on postoperative 24 h(P<0.05),and there were no statistically significant differences between two groups in the psychological support and physical independence(P>0.05).No significant diffrences in HR and MBP between two groups at T0,T2,T4 and T6(P>0.05).At T1,MBP shows lower in group S than control group(P<0.05),and no significant difference in HR between two group(P>0.05).Group S showed that the level of HR and MBP were significantly below that of group C at T3 and T5(P<0.05).Ramsay sedation scores at T5 and T6 of two groups were comparable(P>0.05),and the incidence of bucking during extubation period in group C was significantly higher than that in group S(P<0.05).VAS score measured at 2 h after the surgery shows significantly reduction in the group S than group C(P<0.05).The postoperative pain at 0.5 h,8 h and 24 h and the times of effective PCIA and opioid consumption on postoperative 24 h has no significant differences between two groups(P>0.05).Compare with group C,the incidence of POST and PONV on postoperative 24 h were obviously lower in group S(P<0.05),and no significant differences were observed on headache and respiratory depression between two groups(P>0.05).Conclusion: Preoperative single ultrasound-guided right SGB could improve the postoperative quality of recovery after thyroid surgery,reducing the the incidence of bucking during extubation period,PONV and POST.