Effects Of Ultrasound-guided Subserratus Anterior Plane Block Combined With Rectus Sheath Block On Postoperative Analgesia,Inflammatory Factors And Immune Function In Patients Undergoing Laparoscopic Gastric Cancer Surgery

Objective:To investigate the effect of ultrasound-guided subserratus anterior plane block（SAPB）combined with rectus sheath block（RSB）on postoperative analgesia,inflammatory factors and immune function in patients undergoing laparoscopic gastric cancer surgery.Methods:Sixty patients who received laparoscopic radical gastrectomy under general anesthesia in our hospital were selected and randomly divided into group C and Group R,with 30 cases in each group.Group R received bilateral sub SAPB+RSB:0.25%ropivacaine in total 60ml,including bilateral sub SAPB in total 40ml and bilateral RSB in total 20ml after general anesthesia induction.Group C received general anesthesia only.Hemodynamic indexes of the patients were recorded,including mean arterial pressure（MAP）and heart rate（HR）at each moment:5min after entering the operating room（T₁）,5min before skin resection（T₂）,5min after skin resection（T₃）,30min after pneumoperitoneum（T₄）and the time of abdominal closure（T₅）;The total amount of propofol and remifentanil used during the operation were recorded,and VAS scores were collected at 2h（t₁）,6h（t₂）,12h（t₃）,24h（t₄）,48h（t₅）in resting state and coughing activity after the operation.The levels of T lymphocyte subsets（CD3+,CD4+,CD8+,CD4+/CD8+）and inflammatory cytokines IL-6,IL-8 and IL-10 in peripheral venous blood were measured before operation（t₀）、24 hours after operation（t₄）and 72hours after operation（t₆）.The first request time for PCA bolus after surgery,the total number of times to press the PCA bolus within 48 hours,and the proportion of patients using tramadol hydrochloride for analgesic relief were collected.The occurrence of adverse reactions was recorded.Results:（1）Intra-group comparison:Compared with T₁,MAP and HR in group R were lower at each time point of T₂～T₅,while those in group C were lower at T₂and higher at T₃to T₄（P<0.05）;Compared with T₂,MAP and HR of group C at T₃～T₅and group R at T₃～T₄were significantly higher（P<0.05）.Inter-group comparison:Compared with group C,MAP and HR of group R were obviously lower at T₃～T₅（P<0.05）.There were no significant differences in MAP and HR at T₁and T₂between the two groups（P>0.05）.（2）The total amount of propofol and remifentanil used in group R were reduced than that in group C（P<0.05）.（3）The VAS scores of the R group were lower than those of group C in resting state and coughing activity at T₁～T₅（P<0.05）.（4）Intra-group comparison:Compared with t₀moment,the levels of immune function indexes CD8⁺and CD4⁺/CD8⁺in both groups were decreased at t₄and t₆time points（P<0.05）.However,at t4,CD4⁺level in group R was slightly decreased,but the difference was not statistically significant（P>0.05）;At t₆,there was no significant difference in the levels of CD3⁺and CD4⁺in group R and in the levels of CD4⁺in group C compared with at time point of t₀（P>0.05）.Inter-group comparison:Compared with group C,the levels of CD3⁺,CD4⁺and CD8⁺of various indicators of immune function in group R at t₄were higher（P<0.05）,and there was no difference in the levels of CD4⁺/CD8⁺.The level of CD3⁺in group R at t₆point was higher than that in group C（P<0.05）,and there was no statistical significance in other indexes of immune function（P>0.05）.（5）Compared with t₀moment,the levels of IL-6,IL-8 and IL-10 in group C and group R were increased at t₄and t₆moment（P<0.05）,but the levels of IL-6 and IL-8 in group R were significantly lower than those in group C（P<0.05）.The level of IL-10 was significantly higher than that of group C（P<0.05）,but there was no significant difference in inflammatory factors between two groups at time point of t₀（P>0.05）.（6）The first request time for PCA bolus in group R was longer than in group C（P<0.05）;The pressing times of PCA bolus within 48 hours after operation were significantly less in group R（P<0.05）;The proportion of relief analgesia in group R was lower than that in group C（P<0.05）.（7）There was no significant difference in the incidence of postoperative adverse events between group C and group R（P>0.05）.Conclusions:（1）Ultrasound-guided subserratus anterior plane block（SAPB）combined with rectus sheath block（RSB）is a simple and effective combined regional nerve block technique.（2）Compared with general anesthesia alone,block technique combined with general anesthesia can reduce the fluctuation of intraoperative hemodynamics and reduce the dosage of propofol and remifentanil,so as to effectively control postoperative pain.（3）The reduction of perioperative inflammatory response is beneficial to the recovery of patients’immune function,which provides a safer and ideal analgesic mode for patients with laparoscopic radical gastrectomy.