Effect Of Ultrasound-guided Right Stellate Ganglion Block On Postoperative Visceral Pain And PONV In Patients Undergoing Laparoscopic Cholecystectomy

Background and Aims Laparoscopic cholecystectomy（LC）has become a preferred method for the treatment of benign gallbladder diseases such as gallstones due to its small incisions,low risk of infection,and rapid recovery.However,the incidence of visceral pain during 24 h after LC is still very high and severe visceral pain in the early postoperative period may be associated with chronic pain.Postoperative nausea and vomiting（PONV）cause electrolyte imbalance,slow down wound healing,and make against rapid postoperative recovery.It is generally believed that postoperative visceral pain and PONV are closely related to visceral nerve activity and inflammatory response.Stellate ganglion block（SGB）,as a kind of sympathetic nerve block,can regulate autonomic nervous function and inhibit inflammatory response,and has been widely used in the treatment of a variety of painful or non-painful diseases.Ultrasound-guided SGB may be a safe and effective anesthesia auxiliary technology in perioperative period,which can inhibit intraoperative hemodynamic fluctuations,alleviate postoperative pain and PONV,promote postoperative gastrointestinal function recovery,and improve postoperative sleep quality.Therefore,this study mainly aims to evaluate the effects of ultrasound-guided right SGB on postoperative visceral pain and PONV,and secondarily aims to explore the influence of SGB on intraoperative cardiovascular stress response,postoperative gastrointestinal function recovery and postoperative sleep quality in patients undergoing LC.Methods 132 patients,ASAⅠ-Ⅱ,aged 18-65,scheduled for elective LC were selected in our hospital.The patients were divided into SGB group（n=66）and control group（n=66）using a random number table.Ultrasound-guided right SGB was conducted with 1%lidocaine 6 mL before surgery in SGB group and the equal volume of normal saline was given at the same site in control group.Local infiltration anesthesia at incision sites was performed with 1%ropivacaine 10 mL at the end of surgery in both groups.General information of patients was recorded before surgery.The mean arterial pressure（MAP）and heart rate（HR）were recorded at different time points,including before anesthesia induction（T₀）,after endotracheal intubation（T₁）,skin incision（T₂）,pneumoperitoneum establishment（T₃）,10 min after pneumoperitoneum establishment（T₄）and at the end of surgery（T₅）.Postoperative visceral pain scores evaluated by the Numerical Rating Scale（NRS）at four times（0.5 h,4 h,12 h,24 h after surgery）,incidence of PONV and rate of using antiemetics during the first 24 h after surgery were recorded.The operation time,total dose of propofol and remifentanil,extubation time,first anal exhaust time,Athens Insomnia Scale（AIS）scores on first night after surgery,and satisfaction scores were recorded as well.Results A total of 120 patients undergoing elective LC were included in this study for analysis of results,including 59 males and 61 females.There were no significant differences in gender,age,body weight,operation time,propofol and remifentanil consumption and extubation time between the two groups（P>0.05）.The MAP and HR were significantly lower in SGB group than those in control group at T₁ and T₄（P<0.05）.Compared with control group,SGB group showed lower NRS scores of visceral pain at 4 h and 12 h after surgery,lower incidence of PONV and lower rate of using antiemetics（P<0.05）.Meanwhile,earlier first anal exhaust,lower AIS scores on first night after surgery and higher satisfaction scores were observed in SGB group（P<0.05）.Conclusion Ultrasound-guided right SGB can help maintain intraoperative hemodynamic stability,alleviate postoperative visceral pain,reduce the incidence of PONV,promote postoperative recovery of gastrointestinal function,and improve the quality of sleep after surgery in the patients undergoing LC.