Effect Of Stellate Ganglion Block On Postoperative Sleep Disturbance In Patients Undergoing Radical Surgery For Gastrointestinal Malignancies

ObjectivePostoperative sleep disturbance（POSD）is one of the manifestations of postoperative brain dysfunction,which can adversely affect postoperative recovery,such as increased risk of delirium,pain sensitivity and cardiovascular events,and is gradually becoming one of the perioperative complications of concern.Stellate ganglion block（SGB）can improve sleep quality by suppressing sympathetic ganglion excitability and regulating autonomic function.This study aims to investigate the effect of stellate ganglion block on postoperative sleep disorders in patients undergoing laparoscopic radical surgery for gastrointestinal malignancies,and to provide a reference for clinical prevention and treatment of POSD.MethodsForty patients undergoing elective laparoscopic radical surgery for gastrointestinal malignancies were randomly divided into Group S（SGB treatment:preoperative left-sided SGB intervention）and Group C（control group:no preoperative SGB intervention）,20 patients in each group.General anesthesia combined with epidural anesthesia was performed in both groups.Demographic data,including gender,age,height,weight,American society anesthesiologists（ASA）classification,surgical category and perioperative related indexes were recorded.The total sleep time（TST）,sleep efficiency,sleep maintenance rate,sleep period change index,wake after sleep onset（WASO）,number of wakefulness,and number of body movements were recorded with a actigraphy recorder on the first night before surgery and on the 1^st,2^nd and 3^rd postoperative nights.The pittsburgh sleep quality index（PSQI）scale scores and the incidence of POSD were recorded at 1 d（T₀）preoperatively,1 d（T₉）,2 d(T₁₀),3 d(T₁₁),5 d(T₁₂)and 7 d(T₁₃)postoperatively.Heart rate（HR）,mean arterial pressure（MAP）and pulse oxygen saturation（S_PO₂）were recorded before induction of general anesthesia（T₁）,after tracheal intubation（T₂）,at the beginning of surgery（T₃）,1 h after the beginning of surgery（T₄）,2 h after the beginning of surgery（T₅）,at the end of surgery（T₆）,immediately after extubation（T₇）and at 30 min after transferring to the post-anesthesia care unit（PACU）（T₈）.Changes in electrolytes(K⁺、Ca²⁺),lactic acid（LAC）and glucose were recorded at T₁,T₄,T₅ and T₆.Plasma IL-1,IL-6,IL-10,melatonin and S100-βconcentrations were recorded at T₀,T₉ and T₁₀.Results（1）The demographics（gender,age,height,weight,ASA classification,surgical category）and perioperative indices did not statistically significantly differ between the two groups（P>0.05）.The endotracheal tube removal time after the operation was significantly shorter,and the additional doses administered via the analgesia pump within48 h postoperatively and postoperative remedial analgesia were significantly fewer in Group S than in Group C（P<0.05）.No adverse effects,such as puncture site infection,hematoma,nerve injury,or local anesthetic poisoning,were observed;（2）Changes in sleep:Compared with Group C,Group S showed significant improvements in TST,sleep efficiency,and sleep maintenance rate and significant decreases in sleep period change index,the number of awakenings,WASO,and number of body movements,on the 1^st and 2^nd postoperative nights（P<0.05）.Notably,PSQI scores and POSD incidence were significantly lower at T₉ and T₁₀ in Group S than in Group C（P<0.05）;（3）Changes in hemodynamics and blood glucose:Compared with group C,Group S had significantly decreased MAP and HR at T₂,T₃,and T₇（P<0.05）,and significantly lower glucose levels at T₅ and T₆（P<0.05）;（4）Changes in blood testing:Compared with Group C,Group S showed significantly decreased IL-6 at T₉（P<0.05）,significantly decreased IL-1 and increased IL-10 at T₁₁（P<0.05）,significantly decreased S100-βat T₉ and T₁₁（P<0.05）,and significantly increased melatonin at T₉（P<0.05）.ConclusionIn this study,preoperative left-sided SGB improved the sleep duration and sleep quality in the first two postoperative nights,reduced the incidence of POSD and the postoperative inflammatory response,and stabilized perioperative hemodynamics of patients undergoing radical gastrointestinal malignancy surgery.