Effect Of Erector Spinae Plane Block With Hydromorphone And Ropivacaine On Analgesia And IL-6 In Patients Undergoing Modified Radical Mastectomy For Breast Cancer

Objective To observe the effect of single point single pass ultrasound guided erector spinae plane block with hydromorphone hydrochloride injection combined with ropivacaine on postoperative analgesia and inflammatory factor IL-6 concentration in patients undergoing modified radical mastectomy under general anesthesia.Methods From October 2021 to September 2022,90 female patients with breast cancer who planned to undergo modified radical mastectomy under general anesthesia in Xing’an League People’s Hospital were selected,The classification of American Association of Anesthesiologists was grade I to II,age 45 to 65 years old,body mass index 18 to 30 kg/m~2,and the estimated operation time was 1 to 3 hours.90 patients who met the above criteria were randomly divided into three groups(group C,group R and HR)with 30 patients in each group.Group C(blank control group)received general anesthesia only,group R received general anesthesia after ESPB with 30 ml of 0.5%ropivacaine,and HR group received general anesthesia after ESPB with 30 ml of 0.5%ropivacaine+0.5 mg hydromorphone.The observation indexes were as follows:(1)Detect and record the concentration of inflammatory factor IL-6 in three groups of patients at the time of returning to the ward after surgery(T1)and at 6 a.m.on the first day after surgery(T2);(2)The VAS scores at 4 hours(T3),12 hours(T4)and 24 hours(T5)after operation were recorded by visual analogue scale(VAS);(3)The intraoperative consumption of propofol,remifentanil and sufentanil was recorded in three groups;(4)The number of patients in the three groups who received postoperative relief analgesia(sufentanil)was recorded;(5)Record the number of postoperative adverse reactions(nausea,vomiting)in three groups of patients;(6)The time of the first postoperative exhaust and the time of getting out of bed were recorded.Results(1)Comparison of IL-6 concentration at T1 and T2 time points in three groups:there was no statistically significant difference in IL-6 concentration at T1 time point(P>0.05).Compared with IL-6 concentration at T2 time point,HR group was lower than R group and C group,and the difference was statistically significant(P<0.05);(2)Comparison of anesthetic maintenance drug consumption among the three groups of patients during operation:the dosage of remifentanil,sufentanil and propofol in the three groups was different,and the dosage of HR group and R group was lower than that of C group,the difference was statistically significant(P<0.05);(3)Comparison of VAS pain scores at different time points after surgery among three groups of patients:There were differences in VAS scores at T3,T4,and T5.The VAS scores of HR group and R group were lower than those of C group at T3,T4,and T5,and the difference was statistically significant(P<0.05);(4)Analysis of postoperative rescue analgesia in three groups:the proportion of postoperative rescue analgesia in three groups was statistically different.The proportion of postoperative rescue analgesia in HR group and R group was less than that in C group,with statistically significant difference(P<0.05);(5)The analysis of postoperative adverse reactions in the three groups showed that there was no significant difference in the proportion of postoperative nausea among the three groups(P>0.05),There was a difference in the proportion of postoperative vomiting among the three groups,with the difference being statistically significant(P<0.05);(6)Comparative analysis of the first postoperative exhaust time and first bedridden time among three groups of patients:The first exhaust time and bedridden time in the HR and R groups were both shorter than those in the C group(P<0.05).Conclusion The modified radical mastectomy with erector spinae plane block combined with general anesthesia can reduce the perioperative consumption of opioids and propofol,relieve postoperative pain,accelerate exhaust,reduce vomiting and other adverse reactions,which is conducive to postoperative rehabilitation of patients.Erector spinae plane block with hydromorphone combined with ropivacaine can reduce the concentration of inflammatory cytokines IL-6 in the morning of the first day after modified radical mastectomy under general anesthesia.