Effect Of Erector Spinae Plane Block On Perioperative Stress And Analgesia In Patients Undergoing Endoscopic Radical Esophagectomy

ObjectiveTo study ultrasound-guided erector spinae plane block on perioperative stress response and analgesia in patients undergoing thoracoscopic and lapacoscopic esophagectomy.In order to evaluate the safety,feasibility and clinical application advantages of erector spinae plane block in thoracoscopic and lapacoscopic esophagectomy patients,to explore more advantageous anesthesia methods for TLE patients.And provide more reliable basis for the promotion of this anesthesia method.MethodsSixty patients undergoing thoracoscopic and laparoscopic esophagectomy from January 2020 to January 2021 in The Affiliated Cancer Hospital of Zhengzhou University,aged 40～70 years,ASA grade I～II,weight 50～80 kg,BMI 18～25kg/m²,were divided into two groups:30 patients in general anesthesia group（group C）and 30patients in the general anesthesia combined with erector spinae plane block group（group E）.All research object are the first thoracoscopic and laparoscopic esophagectomy patients in the morning.In group E,ESPB was conducted at the level of the right T5 and bilateral T8 under ultrasound guidance before the anesthesia induction.The block range was determined by loss of cold sensation 20 minutes after the injection.No nerve block in group C.In both groups,the methods of induction and maintenance of anesthesia were the same.The depth of anesthesia was monitored by BIS throughout the operation in both groups.Patient controlled intravenous analgesia was used after operation.Observation indicators:the intraoperative fluid infusion,bleeding volume,and operation time were recored;the intraoperative sevoflurane and remifentanil dosage were recored;mean arterial pressure and heart rate were recored in 5 minutes after internal jugular vein puncture（T₀）,the end of thoracic operation（T₁）,after surgery（T₂）,and 24 hours after surgery（T₃）,and at T₀,T₁,T₂,T₃,blood was drawn from the internal jugular vein to detect the concentrations of epinephrine,norepinephrine,and cortisol;record pain visual analogue scale/score（VAS）for rest and cough at 1,6,12 and 24 hours after surgery;record the effective number of PCIA pump compressions and the total amount of sufentanil infusion within 24 hours after surgery;record the postoperative adverse reactions,including nausea and vomiting,respiratory depression,skin itching,and the ESPB-related complications;record and the patient’s postoperative analgesic satisfaction score.Results（1）General indicators:There were no statistically significant differences in gender,age,weight,body mass index,operation time,intraoperative blood loss,and fluid infusion volume between the two groups（P>0.05）.（2）Intraoperative related indicators:There were no statistically significant differences in operation time,intraoperative blood loss,and fluid infusion volume between the two groups（P>0.05）.Compared with group C,the intraoperative sevoflurane and remifentanil dosage in group E were significantly reduced,the difference is statistically significant（P<0.05）.（3）Hemodynamics and stress indicators:Compared with T₀,the difference in MAP and HR of the two groups at T₁～T₃ was statistically significant（P<0.05）.Comparison of the two groups,there was no statistically significant difference in MAP and HR at T₀～T₃（P>0.05）.Compared with T₀,there was no statistically significant difference in the concentrations of epinephrine and norepinephrine of the two groups at T₁ and T₂（P>0.05）.Compared with T₀,there was statistically significant difference in the concentrations of epinephrine and norepinephrine of the two groups at T₃（P<0.05）;Compared with T₀,there was statistically significant difference in the concentrations of cortisol of the two groups at T₁（P<0.05）;Compared with T₀,there was no statistically significant difference in the concentrations of cortisol of the two groups at T₂ and T₃（P>0.05）;There was no significant difference in the concentrations of epinephrine,norepinephrine,and cortisol at the T₀～T₃ of the two groups（P>0.05）.（4）Related indicators for postoperative follow-up:Compared with group C,the pain VAS scores of resting and coughing at 1,6,12 and 24 hours after operation in group E were significantly reduced,the difference is statistically significant（P<0.05）.Compared with group C,the effective number of PCIA pump compressions and the total PCIA pump sufentanil infusion within 24 hours after operation in group E were significantly reduced,the difference is statistically significant（P<0.05）.All patients in group E had no block-related complications.Compared with group C,the incidence of postoperative nausea and vomiting,respiratory depression,skin itching in group E were lower,but the difference was not statistically significant（P>0.05）.Compared with group C,the postoperative satisfaction score of group E was significantly higher,the difference is statistically significant（P<0.05）.ConclusionsGeneral anesthesia combined with erector spinae plane block and general anesthesia have the same effect on stress response inhibition,and can effectively reduce the consumption of sedative and analgesic drugs during the perioperative period,relieve postoperative pain,improve postoperative analgesia satisfaction of patients,it can be safely and effectively applied to patients undergoing thoracoscopic and laparoscopic esophagectomy.