Effect Of Erector Spinae Block On Stress Response And Postoperative Rapid Recovery In Patients Undergoing Thoracoscopic Radical Mastectomy

Objective:To investigate the effect of ultrasound-guided unilateral erector spinae block on inflammatory response,stress response and rapid recovery after thoracoscopic radical surgery.Methods:Forty-two patients undergoing thoracoscopic radical resection of lung cancer,ASAI or II,were randomly divided into two groups according to the random number table,with 21 cases in each group?n=21?.ESP group?group E?:ultrasound-guided unilateral erector spinae block+intravenous general anesthesia group;TIVA group?T group?:purely intravenous anesthesia group.Both groups underwent radial artery puncture and central venous puncture under local anesthesia.Patients in group E underwent ultrasound-guided ESP blockade at the T₅ transverse process level 30 min before induction of anesthesia.General anesthesia was performed after satisfactory blockade.Group T was general anesthesia.Both groups were induced with dexmedetomidine hydrochloride,propofol,sufentanil,and cis-atracurium.A suitable double-lumen bronchial cannula was selected.The patients in both groups were examined for serum by enzyme-linked immunosorbent assay?ELISA?for 30 min?T₁?,1 h?T₃?,and 4h?T₅?after 24h?T₇?.Concentrations of interleukin-6?IL-6?,interleukin10?IL-10?,cortisol?Cor?,and angiotensin II?Ang-II?.The mean arterial pressure?MAP?and heart rate?HR?levels of perioperative normal hemodynamic parameters,total intraoperative propofol and remifentanil,intraoperative blood loss and total infusion,and surgery were observed.Post-extraction time and length of hospital stay;recorded dynamic visual analogue scale?VAS score?at T₅,T₇,T₈ time points;The total amount of analgesic pump sufentanil infusion,the number of effective additions,and the total number of nausea,vomiting,and dizziness within 48 hours after surgery were recorded.The difference was statistically significant at P<0.05.Results:1.General patient condition,intraoperative blood loss and total infusion results:There was no significant difference between the two groups?P>0.05?.2.Perioperative general hemodynamic parameters?MAP,HR?results:T₁,T_7-8time points,there was no significant difference between the two groups of MAP and HR groups?P>0.05?;compared with the T group,Patients in group E had significantly lower MAP and HR levels at time T_2-6,and the difference was statistically significant?P<0.05?.3.The total intraoperative dose of propofol and remifentanil:Compared with the T group,the doses of propofol and remifentanil in the E group were significantly reduced,the difference was statistically significant?P<0.05?.4.Results of extubation time and length of hospital stay:Compared with group T,the time of extubation and the number of hospital stays in group E were significantly shorter,and the difference was statistically significant?P<0.05?.5.Dynamic and static VAS scores and use of analgesia pump within 24 hours after operation:The dynamic and static VAS scores of T₅,T₇ and T₈ in group E were significantly lower than those in group T,the difference was statistically significant?P<0.05?.Compared with the T group,the total infusion and the number of effective additions of the analgesic pump sufentanil were reduced within 24 hours after the E group.The difference was statistically significant?P<0.05?.6.Serum IL-6 and IL-10 concentration results:There was no significant difference in IL-6 and IL-10 concentrations between the two groups at the time of T₁?P>0.05?;compared with the T₁ time point,the two groups of patients The concentrations of IL-6 and IL-10 were significantly increased at T₃,T₅ and T₇,and the difference was statistically significant?P<0.05?.Compared with T group,the concentration of IL-6 at T₃,T₅ and T₇ in group E was higher than that in group T.The differences were statistically significant?P<0.05?.Compared with the T group,the IL-10 concentrations at the T₃,T₅,and T₇ time points in the E group were significantly higher,and the difference was statistically significant?P<0.05?.7.Serum Cor and Ang-II concentration results:There was no significant difference between the two groups in the Cor and Ang-II concentration groups at the T₁ time point?P>0.05?;compared with the T₁ time point,the two groups of patients T₃,T₅,The concentrations of Cor and Ang-II were significantly increased at T₇,and the difference was statistically significant?P<0.05?.Compared with T group,the concentrations of Cor and Ang-II at T₃,T₅ and T₇ were significantly decreased in group E.The difference is statistically significant?P<0.05?.8.Number of adverse reactions within 48 hours after surgery:There was no significant difference in the total number of people with nausea,vomiting,and dizziness within 48 hours after surgery?P>0.05?.Conclusion:1.Total intravenous anesthesia combined with erector spinae block can inhibit inflammation and stress response in patients undergoing thoracoscopic lung cancer radical surgery.2.Ultrasound-guided unilateral erector spinae block combined with total intravenous anesthesia is beneficial to patients with rapid postoperative recovery,which may be a more appropriate form of anesthesia.