The Effect Of Intercostal Nerve Blockade Combined With General Anesthesia On The Stress Response In Patients Of Minimally Invasive Mitral Valve Surgery

Object To explore the effect of intercostal never blockade combined withgeneral anesthesia on stress response and postoperative recovery in patientsundergoing minimally invasive mitral valve surgery.Methods Thirty ASA II-III and NYHA II-III patients with rheumatic heartdisease undergoing minimally invasive mitral valve replacement surgery wererandomly divided into two groups （n=15）: Intercostal nerve block combined withgeneral anesthesia （group A）,Tranditional general anesthesia （group B）. Two groupsof patients in the awake stake received radial artery catheterization and central venouscatheterization with local anesthesia. Then the group A received0.5%Ropivacaineintercostal nerve blockade from T3to T7before anesthesia induction.Anesthesia wasinduced with midazolam、sufentanil、propofol、vecuronium. Tracheal intubation withappropriate model left dianeter double-lumen endotracheal tube. The central venousblood and radial artery blood were collected at the following time points: the centralvenous catheterization（T₁）,5minutes berfore cardiopulmonary bypass （T₂）,perioperative（T₃）,24hours after operation（T₄）, and the plasma concentrations ofCortisol,IL-6,TNF-α were assessed by radioimmunoassay （RIA）, the glucose wasmeasured by blood glucose meter. The sufentanil consumption, the time for trachealertubation,the hours in the ICU,the scorings of visual analog scale（VAS） and thecomplication of intercostal nerve blockade were recorded. A probability of smallerthan0.05was accepted as significant.Results1.Glu: Glu at T2、T3、T4in group B were significantly increased thanthose in group A（P＜0.05）.Glu at T3、T4im group A were significantly increasedcompared with T1（P＜0.05）; Glu at T2、T3、T4in group B were significantly higherthan T1（P＜0.05）.2.Cortisol:: Cor at T2、T3、T4in group B were significantly increased thanthose in group A（P＜0.05）; Cor at T2in group A was lower than T1（P＜0.05）,T3、T4in group A were significantly increased compared with T1（P＜0.05）; Cor at T3、T4in group B were significantly higher than T1（P＜0.05） 3.IL-6: IL-6at T2、T3、T4in group B were significant higher than those ingroup A（P＜0.05）; IL-6at T2、T3、T4im group A were significantly increasedcompared with T1（P＜0.05）; IL-6at T2、T3、T4in group B were significantlyhigher than T1（P＜0.05）4.TNF-α: TNF-αat T2、T3、T4in group B were significantly higher than thosein group A（P＜0.05）; TNF-αat T2、T3in group A were significantly increasedcompared with T1（P＜0.05）; TNF-αat T2、T3、T4in group B were significantlyhigher than T1（P＜0.05）.5. Sufentanil consumption: The sufentanil consumption in group A wassignificantly lower than the group B（P＜0.05）.6.The traeheal extubation time and the hours of staying in ICU in group A weresignificantly lower than the group B（P＜0.05）;The VAS scoring of pain at T4ingroup B was significantly increased compared with group A（P＜0.05）.7.Complication:None of side affect in the intercostal nerve blockade occurred.Conclusion Intercostal nerve blockade combined with general anesthesia caninhibit the stress response of minimally invasive mitral valve surgery,reduce thesufentanil consumption,benefit for early tracheal extubation,shorten the time ofstaying in ICU,attenuate postoperative pain.It is save and suitable for clinical practice.