| Objective:To evaluate the effect of right stellate ganglion block on shoulder pain after laparoscopic cholecystectomy.Methods:From April 2022 to August 2022,114 patients undergoing LC in the affiliated Hospital of Yan’an University were randomly divided into two groups:experimental group and control group.6 patients were excluded in the experimental group(1 case with BMI<18.5 kg/;1 case was converted to laparotomy;1 case failed in nerve block;2 cases were operated for more than 2 hours;and 1 case refused to use PCIA after operation).And 4 patients in the control group were excluded(3 cases with BMI<18.5 kg/ and 1 case refused to use PCIA after operation).Therefore,a total of104 patients were included in the final analysis,51 cases in the experimental group and53 cases in the control group.Experimental group: after endotracheal intubation and before the operation,4 m L of 0.2% ropivacaine was used for ultrasound-guided right SGB;control group: 4 m L of 0.9% sodium chloride injection was injected at the same site.Surgeons connect PCIA of the same formula to both groups of patients at the beginning of the cover.The incidence of shoulder pain within 48 hours after operation(>2 as meaningful shoulder pain);the VAS score and BCS comfort score of shoulder pain immediately after operation,2 hours,6 hours,12 hours,24 hours and 48 hours after operation;the duration of shoulder pain;the hemodynamic parameters of 5 minutes after entering the operating room(T0),immediately before pneumoperitoneum(T1),immediately after pneumoperitoneum(T2)and immediately after cholecystectomy(T3)were recorded.The use of analgesics within 48 hours after operation,the remedial analgesia within 48 hours after operation,the recovery in hospital and the occurrence of adverse reactions were recorded.Results:No statistically significant difference was found in sex,height,weight,BMI,ASA grade,duration of pneumoperitoneum and use of drainage tube between the two groups(P>0.05),but the difference was statistically significant in age between the two groups(P<0.05).The number of patients with shoulder pain in the experimental group(17.6%)was significantly lower than that in the control group(43.4%)(P<0.05).The duration of shoulder pain in the experimental group was shorter than that in the control group(P<0.05).The VAS of shoulder pain in the experimental group was significantly lower than that in the control group at 6h,12 h and 24 h after operation(P<0.05),but no statistically significant difference was found in VAS between the experimental group and the control group at the end of operation,2h and 48 h after operation(P> 0.05).The difference was statistically significant in BCS between the experimental group and the control group at 12 h and 24 h after operation(P<0.05),but no statistically significant difference was found in BCS between the test group and the control group at the end of operation,2h,6h and 48 h after operation(P>0.05).The consumption of sufentanil within48 hours,the effective pressing times of PCIA,the salvage analgesia rate and the dosage of ketorolac tromethamine in the experimental group were lower than those in the control group(P<0.05),but no statistically significant difference was found in the duration of PCIA between the two groups(P>0.05).The difference was statistically significant in heart rate at T1 and their respective T0 between the experimental group and the control group(P<0.05),but no statistically significant difference was found in the heart rate at T2,T3 and their respective T0 in the experimental group and the control group(P>0.05).The difference was statistically significant in systolic blood pressure at T1,T2,T3 and their respective T0 between the experimental group and the control group(P<0.05).The difference was statistically significant in diastolic blood pressure at T1 and their respective T0 in the experimental group and control group,and T3 and respective T0 in the control group(P < 0.05).but no statistically significant difference was found in diastolic blood pressure between T2 and their respective T0 in experimental group and control group,and T3 and respective T0 in the experimental group(P > 0.05).The difference was statistically significant in mean arterial pressure at T1,T3 and their respective T0 in the experimental group and the control group(P < 0.05),but no statistically significant difference was found in mean arterial pressure between T2 and their respective T0 in the experimental group and the control group(P>0.05).The first postoperative exhaust time and the first time to get out of bed in the experimental group were significantly earlier than those in the control group(P<0.05).The incidence of nausea in the experimental group(13.7%)was significantly lower than that in the control group(30.2%)(P<0.05).No statistically significant difference was found in vomiting,abdominal distension,hoarseness and dyspnea between the two groups(P>0.05).Conclusion:Right SGB can reduce the incidence of shoulder pain after LC,relieve the pain degree of PLSP,facilitate intraoperative management,and improve the quality of postoperative recovery.In clinical practice,SGB under the guidance of ultrasound is a simple and safe method to improve PLSP. |
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