The Effect Of Ultrasound-guided Great Auricular Nerve And Lesser Occipital Nerve Block On Patient Undergoing Radical Mastoidectomy

Part 1 Effectiveness and Safety of Ultrasound-guided Great Auricular and Lesser Occipital Nerve Blocks on Patients Undergoing Radical MastoidectomyObjective To investigate the effectiveness and safety of ultrasound-guided great auricular and lesser occipital nerve blocks on patients undergoing radical mastoidectomy.Methods A double-blind randomly controlled study was performed.According to inclusive criteria,a total of 80 patients undergoing radical mastoidectomy were randomly separated into two groups:control group(group P)and nerve block group(group NB).Each group contained 40 cases.Patients of both group received ultrasound-guided great auricular and lesser occipital nerve blocks.Patients of group NB received nerve blocks with 0.375%ropivacaine 2ml each nerve,while patients of group P received nerve blocks with 0.9%Sodium Chloride 2 ml each nerve.Regions of numbness were detected by needle 5 minute after nerve blockage.Patients of both groups received total intravenous general anesthesia with intubation once nerve block was confirmed,or quit the experiment once nerve block failed.During operation,target Controlled Infusion(TCI)of propofol and remifentanil was set at minimum speed according to vital signs and bispectral index(BIS)which was targeted in range 40?60.Cis-atracurium was injected when needed.After operation,patients were transferred to Post-anesthesia care unit(PACU)to extubation and resuscitation.The duration of PACU stay was depended on consciousness recovery,occurring of adverse effect of complication.The general conditions and biochemical examinations of patients were collected.Length of general anesthesia and operation,total infusion in operation,administration of ephedrine and urapidil,anesthetic consumptions and arterial blood gas analysis of each patient were recorded.Mean blood pressure(MBP),heart rate(HR),pulse oxygen saturation(Sp O₂)and temperature(Temp)were monitored and recorded at 10 time points:entering operation room(T₀),intubation(T₁),skin incision(T₂),0.5 h after skin incision(T₃),1 h after skin incision(T₄),1.5 h after skin incision(T₅),2 h after skin incision(T₆),termination of operation(T₇),extubation(T₈)and leaving PACU(T₉).Also,time from termination of operation to extubation(marked as extubation time),duration of PACU stay and rates of postoperative adverse effect were recorded.Results The outcomes indicated that no significant difference in comparison of general conditions and biochemical examinations between two groups(P>0.05).Compared with group P,unit time consumptions of propofol and remifentanil during operations were significantly decreased in group NB(P<0.05).There was no significant difference between group NB and group P in comparison of total consumptions of propofol,remifentanil,cis-atracurium,ephedrine and urapidil(P>0.05).Meanwhile,no significant difference was found in comparisons of length of anesthesia,length of operation,transfusion quantities,operative arterial blood gas analysis and perioperative vital signs between two groups(P>0.05).Compared with group P,extubation time and duration of PACU stay were significant shorter in group NB(P<0.05).The rates of postoperative nausea and vomiting(PONV)were significantly decreased in group NB when compared to group P(P<0.05).At last,there was no difference between two groups in comparison of rescue analgesic consumptions(P>0.05).Conclusions Ultrasound-guided great auricular and lesser occipital nerve blocks reduce unit time consumptions of anesthetic,shorten extubation time and duration of PACU stay and decrease rates of PONV effectively,which provide safe and effective perioperative analgesia for patients undergoingPart 2 Effect of Ultrasound-guided Great Auricular and Lesser Occipital Nerve Blocks on Postoperative Recovery of Patients Undergoing Radical MastoidectomyObjective To investigate the effect of ultrasound-guided great auricular and lesser occipital nerve blocks on postoperative recovery of patients undergoing radical mastoidectomy.Methods A double-blind randomly controlled study was performed.Eighty patients undergoing radical mastoidectomy were randomly separated into two groups according to inclusive criteria: control group(group P)and nerve block group(group NB).Each group contained 40 cases.Patients of both groups received ultrasound-guided great auricular and lesser occipital nerve blocks.Patients of group NB received nerve blocks with 0.375% ropivacaine 2 ml each nerve,while group P with 0.9% Sodium Chloride 2 ml each nerve.Regions of numbness were detected by needle 5 minute after nerve blockage.Patients of both groups received total intravenous general anesthesia with intubation once nerve block was confirmed,or quit the experiment once nerve block failed.During operation,target Controlled Infusion(TCI)of propofol and remifentanil was set at minimum speed according to vital signs and bispectral index(BIS)which was targeted in range 40⁶0.Cis-atracurium was injected when needed.After operation,patients were transferred to Post-anesthesia care unit(PACU)to extubation and resuscitation.The general conditions of patients were collected.Length of general anesthesia and operation and total infusion were recorded.Postoperative hospital stay was recorded.The general comfort questionnaire(GCQ)were used to assess the postoperative conform of patients 2 h and 24 h after extubation.The quality of recovery-15 scores of both groups were marked for 3 days after operation.The dimensions scores of emotion state,physical comfort,psychological support,physical independence and pain were marked respectively,as well as global Qo R-15 scores.The simplified Mc Gill pain questionnaire(SF-MPQ)scores were marked for 3 days after operation as well.SF-MPQ is formed by Pain rating index(PRI),Visual analogue scale(VAS)and Present pain intensity(PPI).The scores of PRI,VAS and PPI were counted respectively as well as total scores.Semmes-Weinstein Monofilaments were used to evaluate the touch pain at the second and the third day.Results Eighty cases were included in this randomized controlled experiment(nP=nNB=40).The outcomes revealed that no significant difference in comparison of general condition,length of anesthesia,length of operation and transfusion quantities between two groups(P>0.05).There was no significant difference between two groups in postoperative length of stay as well.Compared with group P,the 2 h GCQ scores were significantly lower in group NB(P<0.05),when there was no significant difference in comparison of 24 h GCQ scores between two groups(P>0.05).The 24 h GCQ scores in both groups were significantly higher than 2 h GCQ scores(P<0.05).Compared with group P,the Qo R-15 scores were remarkably increased in group NB on the first day and second day after operation(P<0.05).The scores of dimensions physical comfort and pain were remarkably higher in group NB on the postoperative days when compared with group P(P<0.05).The scores of dimension psychological support were higher in group NB on the first day after operation as well(P<0.05).The VAS scores and the SF-MPQ scores of patients in group NB were significantly lower than that of patients in group P at the first day,the second day and the third day after operation(P<0.05).Meanwhile,SWME scores of patients in group P were significantly higher than that of patients in group NB(P<0.05).Conclusions Ultrasound-guided great auricular and lesser occipital nerve blocks reduce postoperative pain and improve postoperative comfort.It provides an alternative postoperative recovery therapy for patients undergoing radical mastoidectomy.Part 3 Effect of Ultrasound-guided Great Auricular and Lesser Occipital Nerve Blocks on Inflammation and Stress of Patients Undergoing Radical MastoidectomyObjective To investigate the effect of ultrasound-guided great auricular and lesser occipital nerve blocks on postoperative recovery of patients undergoing radical mastoidectomy.Methods A double-blind randomly controlled study was performed.Eighty patients undergoing radical mastoidectomy were randomly separated into two groups according to inclusive criteria: control group(group P)and nerve block group(group NB).Each group contained 40 cases.Patients of both groups received ultrasound-guided great auricular and lesser occipital nerve blocks.Patients of group NB received nerve blocks with 0.375% ropivacaine 2 ml each nerve,while group P with 0.9% Sodium Chloride 2 ml each nerve.Regions of numbness were detected by needle 5 minute after nerve blockage.Patients of both groups received total intravenous general anesthesia with intubation once nerve block was confirmed,or quit the experiment once nerve block failed.During operation,target Controlled Infusion(TCI)of propofol and remifentanil was set at minimum speed according to vital signs and bispectral index(BIS)which was targeted in range 40⁶0.Cis-atracurium was injected when needed.After operation,patients were transferred to post-anesthesia care unit(PACU)to extubation and resuscitation.The general conditions of patients were collected.Length of general anesthesia and operation and total infusion were recorded.Venous blood of each patient was collected at the timepoints that entering operation room,termination of operation,the first day after operation and the third day after operation.Serum TNF-?,IL-6,IL-10,glucose,NE and ?-EP were detected and analyzed.Results Eighty cases were included in this randomized controlled experiment(nP=nNB=40).The outcomes revealed that no significant difference in comparison of general condition,length of anesthesia,length of operation and transfusion quantities between two groups(P>0.05).The increased levels of IL-6 were significantly lower than that in group P on the first day and the third day after operation(P<0.05).The increased levels of ?-EP and CRH of patients in group NB were significantly lower than that in group P after operation(P<0.05).Besides,CRH level on the first day after operation was significant decreased in group NB(P<0.05).There was no difference between two groups in the rest comparisons of inflammation indicators and stress indicators(P>0.05).Conclusions Ultrasound-guided great auricular and lesser occipital nerve blocks reduce postoperative pain,attenuate inflammation and stress effectively and improve postoperative conform.It provides an alternative postoperative recovery therapy for patients undergoing radical mastoidectomy.