Ji Xiaochen - Application analysis of stellate ganglion block in uterine fibroid removal surgery. Raw data
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Objective To investigate the effectiveness of stellate ganglion block (SGB) in patients undergoing myomectomy. Methods A total of 240 patients who underwent laparoscopic myomectomy at our hospital were randomly divided into a combined block group (n=120) and a general anesthesia group (n=120). Both groups received propofol anesthesia. The combined block group underwent ultrasound-guided right-sided SGB before anesthesia induction, whereas the general anesthesia group received an equal volume of normal saline injection at the stellate ganglion. The perioperative hemodynamics, heart rate variability, postoperative visual analog scale (VAS) pain scores, recovery process, rescue analgesia, adverse reactions, preoperative and postoperative Pittsburgh Sleep Quality Index (PSQI) scores, self-rating anxiety scale (SAS) scores, and inflammatory stress response were compared between the two groups. The results The mean arterial pressure and heart rate at the time of tracheal intubation and extubation, as well as the low-frequency power and low-frequency power/high-frequency power at the time of tracheal intubation, 5 minutes after pneumoperitoneum creation, at the end of surgery, and at extubation, were lower in the combined block group than in the general anesthesia group (P<0.05). The VAS scores at rest at 6 h, 12 h, and 24 h postoperatively, the number of patient-controlled analgesia pumps pressed within 48 h, and the proportion of rescue analgesia in the combined block group were lower than those in the general anesthesia group, whereas the time to first flatus and ambulation was shorter than that in the general anesthesia group (P<0.05). The levels of interleukin-6, cortisol, and norepinephrine at 24 h postsurgery in the combined block group were lower than those in the general anesthesia group (P<0.05). The PSQI and SAS scores at 1 postoperative day were lower in the combined block group than in the general anesthesia group (P<0.05). The incidence of nausea and vomiting, dizziness and headache, and shoulder pain in the combined block group was lower than that in the general anesthesia group (P<0.05). Conclusion Stellate ganglion block in patients undergoing laparoscopic myomectomy can stabilize hemodynamics, maintain autonomic nervous system balance, improve postoperative analgesic effects, reduce the inflammatory stress response and anxiety‒sleep disorder symptoms, promote postoperative recovery, and increase safety. Keywords: Stellate ganglion block; Propofol anesthesia; Laparoscopy; Myomectomy
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①Preoperative Preparation and Monitoring All examinations were completed preoperatively in both groups to exclude surgical contraindications, with routine fasting for 6 hours and no drinking for 4 hours. After the patient entered the operating room, intravenous access was established, and a multifunctional monitor was used to monitor various vital signs routinely. ②Under ultrasound guidance, both groups underwent nerve blocks 15 minutes before anesthesia induction. Patients were placed in a supine position with a thin pillow under the shoulder and the head tilted to the left to fully expose the right neck. After routine disinfection and draping, a high-frequency linear array ultrasound probe was used to explore the area at the level of the cricoid cartilage, identifying anatomical structures such as the carotid artery, longus capitis muscle, and transverse process of the C6 vertebra. For the combined block group, via the intraplane puncture technique, the needle was precisely inserted between the deep prevertebral fascia and longus capitis fascia, avoiding nerves and blood vessels. After confirming that no blood, gas, or cerebrospinal fluid was present during aspiration, 5 mL of 0.375% ropivacaine was slowly injected. Postprocedure observation revealed Horner syndrome (ptosis, miosis, enophthalmos, facial flushing without sweating) as a success indicator. The general anesthesia group was subjected to identical ultrasound localization and puncture methods but received 5 mL of saline solution at the same injection site. ③Both the anesthesia and postoperative analgesia groups followed standardized general anesthesia protocols. Anesthesia induction was initiated via intravenous administration of 2 mg/kg propofol, 0.4 μg/kg sufentanil, and 0.2 mg/kg atracurium. After adequate muscle relaxation was achieved, tracheal intubation was performed, and mechanical ventilation commenced. Maintenance anesthesia was maintained with continuous infusion of 4–6 mg/(kg·h) propofol and 0.1–0.2 μg/(kg·min) remifentanil, with dosage adjustments based on electroencephalographic (EEG) bispectral index (BIS) values (maintained between 40–60) and hemodynamic parameters. Blood pressure and heart rate fluctuations were controlled within ±20% of baseline values, with intermittent additional atracurium administration as needed. At the conclusion of surgery, all patients received a routine connection to a patient-controlled analgesia (PCA) pump. For patients scoring ≥4 on the visual analog scale (VAS) at rest, 50 mg flurbiprofen ester was administered intravenously as rescue analgesia, with the analgesic effect lasting 48 hours.
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- 2025 Hebei Province Medical Science Research Project Plan No. 20251530Grant ID: http://139.9.42.233:8081/SRP/