Ultrasound-guided Erector Spinae Plane Block For Rapid Postoperative Rehabilitation Of Patients Undergoing Open Abdominal Surgery

Objectives:To investigate the effect of single ultrasound-guided erector spinae plane block(ESPB)before anesthesia induction on the rapid recovery of patients undergoing open abdominal surgery.Methods:Eighty patients undergoing open abdominal surgery with right subcostal incision in the Department of Hepatobiliary Surgery of our hospital were selected,male or female,ASA I-II,18-75 years old,body mass index<35 kg/m2,and signed informed consent.According to the random number table,the patients were divided into E and C groups.General anesthesia combined with erector spinae plane block group(group E)and general anesthesia group(group C).Before the induction of anesthesia,Group E patients underwent ultrasound guided T8 transverse process horizontal erector spinae plane block on the right side.Ropivacaine of 0.33%in 30 mL was given.Group C patients did not accept block.All patients used PCIA for pain control at the end of the operation.These following items were recorded:mean arterial pressure(MAP)and heart rate(HR)at patients entering the operating room(TO),5 minutes after skin removal(T1),1 hour after skin removal(T2),before surgery(T3),1 hour after surgery(T4),24 hours after surgery(T6);intraoperative sufentanil and remifentanil doses.VAS pain scores at rest and cough were recorded at 1 h(T4),6 h(T5),24 h(T6),and 48 h(T7)after surgery.The number of effective additions of analgesic pumps,the number of surgeons supplementing pain medications and the occurrence of adverse reactions were recorded within 48 hours after surgery.The levels of inflammatory response mediators IL-6 and IL-10 at T0,T4,T5,and T6 were measured;the time of first postoperative anal exhaust and out-of-bed activity,postoperative hospitalization days,and total hospitalization costs were recorded.Cognitive function was assessed using the Simple Intelligent Mental State Assessment Scale(MMSE)one day before surgery and one,three,and seven days after surgery.Results:1.For general characteristics such as age,sex,body mass index,ASA classification,education level,operation time and operation type,there were no significant differences between group E and group C(P>0.05).2.For hemodynamic indicators,MAP and HR had no significant differences between group E and group C at time points of T0 and T6(P>0.05).Compared with group C,MAP and HR at T1,T2,T3,and T4 time points in group E were significantly reduced(P<0.05).3.For analgesia-related indicators,compared with group C,the amount of sufentanil and remifentanil used during surgery was significantly reduced(P<0.05).Compared with group C,patients in group E had significantly lower VAS scores at rest and cough at T4 and T5 time points(P<0.05).At T6 and T7 time points,the VAS scores at rest and cough had no differences between the two groups.Compared with group C,the effective push number of analgesic pump and the number of cases requiring additional analgesic drugs within 48 hours in group E were significantly reduced(P<0.05).4.For stress-related indicators,at T4,T5,and T6 time points,IL-6 and IL-10 in both groups were significantly higher than T0(P<0.05).There were no significant differences in the levels of IL-6 and IL-10 before surgery between the two groups(P>0.05).at T4,T5,and T6 time points,the IL-6 levels in group E were significantly lower than that in group C(P<0.05);at time points of T4,T5,and T6,IL-10 levels in group E were significantly higher than those in group C(P<0.05).5.For the indexes related to cognitive function,There were no significant differences in the incidence of early postoperative cognitive dysfunction between the two groups of patients(P>0.05).6.For the indexes related to rapid recovery after surgery,compared with the group C,the first time of out-of-bed acitivity and first anal exhaust,the postoperative duration of hospital stays in group E were significantly reduced(P<0.05).There were no significant differences in the total cost of hospitalization between the two groups(P>0.05).7.Regarding the occurrence of adverse reactions within 48 hours after surgery,the incidence of postoperative nausea and vomiting was significantly lower in group E thangroup C(P<0.05).There was no significant difference in the incidence of postoperative dizziness and skin pruritus between group E and goup C(P>0.05).Conclusion:General anesthesia combined with ultrasound-guided erector spinae plane block can reduce the perioperative stress response of patients undergoing open abdominal surgery,maintain stable vital signs during surgery,reduce the use of opioids during surgery,relieve the pain during and after surgery,and reduce the incidence of adverse reactions.Shorten the patient's first time out of bed,anal exhaust,postoperative hospital stay,and speed up the recovery of the open abdominal surgery patients.