Effect Of Ultrasound-guided Serratus Anterior Plane Block On Stress Response And Early Postoperative Quality Of Recovery In Elderly Patients Undergoing Thoracoscopic Surgery

Objective To investigate the effect of ultrasound-guided serratus anterior plane block（SAPB）on the stress response and early postoperative quality of recovery in elderly patients undergoing thoracoscopic surgery.Methods Eighty elderly patients who undergoing thoracoscopic lobectomy were selected and divided into 2 groups which using a random number table method:general anesthesia group（group GA）,serratus anterior plane block combined with general anesthesia group（group SAPB）.In group SAPB,patients received serratus anterior plane block before anesthesia induction.HR and MAP were recorded at before anesthesia（T₀）,during skin incision（T₁）and before extubation（T₄）.2 ml of venous blood samples were collected at the time of T₀,at 5 min after inserting thoracoscopic cannula（T₂）,at closing chest（T₃）,and at 24 h after operation（T₅）for determination of plasma norepinephrine（NE）and adrenaline（E）concentrations by enzyme-linked immunosorbent assay.The clinical pulmonary infection scores（CPIS）on 1 and 3 days and the quality of recovery（Qo R-15）on 1 and 2 days after operation were evaluated.The intraoperative consumption of remifentanil and propofol during surgery and anesthesia recovery time,extubation time,awakening period score（15min after extubation）were recorded.Adverse analgesic reactions of elderly patients such as hypertension and tachycardia during PACU and the incidence of nausea,vomiting and pruritus,dizziness,pneumonia,atelectasis were also recorded.Results1 Comparison of hemodynamic parameters at different time points:MAP and HR at T₁were lower than T₀in group SAPB（P<0.05）.No significant difference between two groups in MAP and HR at T₀（P>0.05）.Compared with group GA,MAP and HR in group SAPB were decreased when at T₁,T₄（P<0.05）.2 Plasma concentrations of NE and E at different time points were compared:Compared with T₀,the plasma concentration of NE and E between two groups were increased at T₂,T₃and T₅（P<0.05）.Compared with group GA,the plasma E and NE concentrations at T₂,T₃,and T₅was decreased in group SAPB（P<0.05）.3 The consumption of propofol and remifentanil use during operation were compared:The consumption of propofol between two groups was no difference.Compared with group GA,the intraoperative consumption of remifentanil was decreased in group SAPB（P<0.05）.4 Comparison of emergence situation after operation in two groups:No difference was found in extubation time,emergence time and agitation score in two groups（P>0.05）.Compared with group GA,the incidence of hypertension and tachycardia during PACU in group SAPB were decreased（P<0.05）.5 Comparison of the incidence of postoperative adverse reactions in two groups:Compared with group GA,the incidence of postoperative nausea and vomiting in group SAPB was decreased（P<0.05）.No difference in the incidence of dizziness,pruritus,pneumonia,and atelectasis in two groups（P>0.05）.6 Comparison of Quality of Recovery-15 scores and clinical pulmonary infection scores after operation:Compared with group GA,Quality of Recovery-15 scores were increased at 1 and 2 days after operation and clinical pulmonary infection scores were decreased at 1 and 3days after operation in group SAPB（P<0.05）.Conclusions Ultrasound-guided SAPB combined with general anesthesia is used for thoracoscopic surgery in elderly patients can help achieve anesthetic model of low-consumption opioids and inhibit stress responses,maintain hemodynamic stability and significantly improving the quality of early postoperative recovery than general anesthesia alone.