Effect Of Serratus Anterior Plane Block On Stress Response In Patients Undergoing Thoracoscopic Cardiac Surgery Extracorporeal Circulation

Objective:To investigate the effect of ultrasound-guided serratus anterior plane block on stress response and postoperative rehabilitation in patients undergoing thoracoscopic cardiac surgery of extracorporeal circulation.Methods:Selecting 40 patients undergoing thoracoscopic cardiac surgery of extracorporeal circulation were selected from our hospital..The ASA rank was grade III.The patients were randomly divided into experimental group(SP group,n=20)and control group(C group,n=20)by random number table.The experimental group underwent ultrasound-guided serratus plane block before anesthesia,and slowly injected 0.5%ropivacaine 20 ml on the surface of the anterior serratus.30 minutes later,the range and effect of the anesthesia were measured,and full intravenous anesthesia would be performed among patients with proper range and satisfactory effect of analgesia.Intravenous anesthesia alone was carried on group C,and both group recieved PCIA after surgery.Both groups received venous blood from the internal jugular vein 4 ml before anaesthesia(T1),before CPB(T2),at the end of CPB(T3),at the end of surgery(T4),and 24 h after surgery(T5).The concentrations of plasma cortisol(COR),IL-6,IL-10,and epinephrine of central venous blood sample were measured by enzyme-linked immunosorbent assay(ELISA).Blood glucose(Glu)concentration can be measured at the same time point by taking blood from the artery for blood gas analysis.The amount of sufentanil,the time of tracheal extubation,the duration of cardiothoracic intensive care unit(ICU),and postoperative complications were observed and compared between the two groups.The analgesic effect of the two groups was compared by visual analog scale(VAS score)24 hours after surgery.The difference was statistically significant at P<0.05.Results:1.The amount of sufentanil in the group SP was significantly lower than that ofgroup C during surgery operation and 24 hours later after operation(P<0.05).2.The length of recovery time,tracheal extubation time,and ICU stay time of cardiothoracic surgery in group SP were significantly less than that of group C(P <0.05).3.Compared with pre-anesthesia(T1),the concentration level of serum IL-6,EPI,COR and blood glucose in the two groups were significantly higher than that of other time points(T2,T3,T4,T5)(P<0.05)and IL-10 concentration decreased significantly(P<0.05)4.Compared with group C,the concentration level of IL-6,EPI,COR and blood glucose of group SP was significantly lower(P<0.05)and IL-10 concentration increased significantly in T2,T3,T4 and T5(P<0.05).5.The VAS score of pain in T group at rest and cough was significantly lower than that in group C(P<0.05).6.Postoperative complications in the group SP were significantly less than that in the group C(P>0.05).Conclusion:Ultrasound-guided serratus plane block combined with total intravenous anesthesia for patients undergoing thoracoscopic cardiac surgery of extracorporeal circulation can significantly reduce traumatic stress response,promote postoperative analgesia,and enhanced recovery after surgery(ERAS).