The Effect Of Ultrasound-guided Serratus Anterior Plane Block On Stress Response Postoperative Analgesia And Lung Function In Patients Undergoing Thoracoscopic Radical Resection Of Lung Cancer

Objective:To analyse the effect of ultrasound-guided serratus anterior plane block on stress response,postoperative analgesia and lung function in patients undergoing thoracoscopic radical resection of lung cancer.Methods:Sixty patients who received elective thoracoscopic lung cancer surgery in our hospital were selected and randomly divided into two groups:control group（group C,n=30）and SAPB group（group S,n=30）.After general anesthesia the patients in group S received SAPB:0.33%ropivacaine 30ml,and the patients in group C did not received SAPB.PCIA was used by all patients in two groups after operation.MAP and HR were collected at entrance to the operating room（T₁）,1min before skin resection（T₂）,5min after skin resection（T₃）,30min after one lung ventilation（T₄）and at the end of surgery（T₅）.The concentration of norepinephrine,interleukin-6 and interleukin-10 were detected at T₁,T₃,T₅and 24h after surgery（T₇）.The oxygen index,respiratory index and intrapulmonary shunt rate were measured at T₁,T₄,30min after extubation（T₆）and T₇.VAS scores at rest and on coughing were taken notes at 4 h,8h,12 h,24 h,48 h postoperatively,as well as the first request time for PCA bolus,the number of request times for PCA bolus and the proportion of rescue analgesia.The incidence of postoperative adverse reactions were recorded.Results:（1）Compared with T₁,MAP and HR decreased in both groups at T₂（P<0.05）;Compared with T₂,MAP and HR increased in both groups at T₃（P<0.05）.In comparison with group C,MAP and HR in group S were significantly lower at T₃,T₄and T₅（P<0.05）.（2）Compared with T₁,the densities of NE,IL-6 and IL-10 in two groups were significantly increased at T₃,T₅and T₇（P<0.05）.In comparison with group C,the concentrations of NE and IL-6 in group S were lower at T₃,T₅and T₇,while the density of IL-10 was higher（P<0.05）.（3）There was no significant difference in OI,RI and Qs/Qt between group C and group S at T₁and T₄（P>0.05）.In comparison with group C,OI in group S was higher at T₆and T₇,however RI and Qs/Qt were lower（P<0.05）.（4）At 4 h and 8 h postoperatively,VAS scores at rest and on coughing in group S were lower than those in group C（P<0.05）.At 12 h,24 h,48 h after operation there was no significant difference in VAS scores at rest and on coughing between the two groups（P>0.05）.The first request time for PCA bolus after surgery in group S was longer than that in group C（P<0.05）.The number of request times for PCA bolus in group S was less than that in group C（P<0.05）.The proportion of rescue analgesia in group S was lower than that in group C（P<0.05）.（5）As far as the incidence of postoperative adverse reactions,there was no significant difference between the two groups（P>0.05）.Conclusion:Ultrasound-guided serratus anterior plane block is an effective adjuvant analgesic technique in thoracoscopic radical resection of lung cancer under general anesthesia.It keeps the hemodynamics of patients more stable during operation,reduces stress response,and improves postoperative analgesia.Moreover it can produce certain lung function protection.Therefore,it can promote rapid recovery of patients.