Clinical Study Of Ultrasound-guided Anterior Serratus Block Combined With Tapb In Radical Resection Of Esophageal Cancer

ObjectiveThe first part:To observe the effect of ultrasound-guided anterior serratus plane block(SPB)block combined with transverse abdominis plane block on the analgesia and postoperative recovery of patients with esophageal cancer.The second part:To observe the effect of ultrasound-guided block of serratus plane(SPB)combined with block of transverse abdominis plane on the postoperative immune function of patients with esophageal cancer.MethodsThe first part:According to the inclusion exclusion criteria,120 patients who underwent radical resection of esophageal cancer in our hospital from January 2019to December 2019 were screened,and those who did not meet the criteria were excluded.The remaining patients were divided into SPB group and control group by random number table method.Anesthesia was carried out before operation.After anesthesia,ultrasound-guided block intervention was carried out before operation.In SPB group,20ml 0.25%ropivacaine was injected into the latissimus dorsi and the anterior serratus,and 20ml saline was injected into the corresponding area in the control group.The anesthesia effect during the operation is maintained,and the bis of patients is maintained at 40-60.At the end of the treatment,the patients were given analgesic measures.The postoperative complications were recorded,and the anesthetic dosage,VAS score and qor-40 score were compared between the two groups.The second part:According to the patients included in the first part of the study,30 patients in each group were selected.The levels of IL-2,IL-6 and IFN-γin the peripheral blood of patients were measured and compared at different time points before and after operation,The levels of IFN-γ)and CD3~+,CD4~+,CD8~+immune cells and CD4~+/CD8~+were measured by flow cytometry.ResultsThe first part:1.There was no significant difference in ICU stay time(16.0±7.2h),hospitalization time(11.2±1.1d)and extubation time(139±21min)between SPB group and control group(17.0±6.3h,11.5±1.3d)(P>0.05)2.At the end of 4 hours after the operation,there was no significant difference between the VAS scores of the SPB group(4,3,3)and the control group(5,4,4)(P>0,05);from 6h to 24h after operation,the VAS score(1,2,2,1)of SPB group was lower than that of the control group(3,5,4,4),which was statistically significant(P<0.05),indicating that SPB could play a better role in relieving pain.3.The use of remifentanil(550.28±95.21 ug/h)and sufentanil(47.13±15.28ug)in the SPB group was lower than that in the control group(742.28±107.07 ug/h,97.28±27.76ug)(P<0.05).4.The QOR-40 total score and single score of patients in SPB group before and after operation were compared with those of patients in the control group.There was no significant difference before operation.The QOR-40 total score(190),pain(29),physical comfort(51)of patients in SPB group after operation were significantly different from those in the control group(184,35,43)(P<0.05).The rest had no significant difference.5.Comparing the postoperative complications of SPB group and control group,there was a significant difference in the occurrence of dizziness(P<0.05).The incidence of patients in SPB group(0)was lower than that in control group(5).There was no significant difference in the occurrence of nausea,vomiting,pruritus,respiratory inhibition and bradycardia.The second part:1.The level of IFN-γin SPB group was 24 hours(59.42±11.36 pg/ml)and48 hours(52.38±8.80 pg/ml)after operation compared with that in control group(32.14±8.79,36.27±4.62 pg/ml),there was significantly difference(P<0.05).2.The level of CD3~+cells in the SPB group was significantly higher than that in the control group(P<0.05);the level of CD8~+cells in the SPB group at 24h and 48h(28.33±8.79,28.11±8.94)was not significantly different from that in the control group(27.41±7.20,25.61±6.12)(P>0.05);the level of CD4~+/CD8~+in the SPB group at 24h(0.70±0.26)was lower than that in the control group(0.91±0.31),other differences are not obvious.ConclusionSPB combined with tap technology can reduce the postoperative pain of patients undergoing radical operation of esophageal cancer.It also has a certain protective effect on the stress response of patients caused by operation and anesthesia,resulting in the reduction of immunity,and reduces the dosage of anesthetic during and after operation,which is conducive to the prognosis of patients.