A single-dose of stellate ganglion block for the prevention of postoperative dysrhythmias in patients undergoing thoracoscopic surgery for cancer

Abstract

BACKGROUND New-onset arrhythmias and sleep disturbances are frequently observed during the postoperative period in patients undergoing thoracic surgery. OBJECTIVE We evaluated the effectiveness of a single-dose stellate ganglion block (SGB) to prevent the occurrence of arrhythmias in patients undergoing thoracic surgery for cancer. DESIGN Randomised controlled double-blind study. SETTING Single university hospital. PATIENTS Ninety patients with lung cancer or oesophagal cancer scheduled for elective video-assisted thoracoscopic surgery were randomly randomised into one of two equal groups (the SGB group and control group, n = 40 each). INTERVENTIONS Patients received a single dose of 5 ml of 0.5% ropivacaine during ultrasound-guided SGB before induction of general anaesthesia in the SGB group. MAIN OUTCOME MEASURES Holter ECG was continuously monitored during the first 48 postoperative hours, and sleep state was monitored during the first two postoperative nights. RESULTS The incidences of postoperative supraventricular tachycardias were lower in the SGB group compared with the control group during the first 48 postoperative hours; 11.6 (5/43) vs. 31.8% (14/44), respectively, P = 0.023 (odds ratio 0.28, 95% confidence interval 0.09 to 0.87). The SGB also prolonged the total sleep time and increased the sleep efficiency during the first two postoperative nights. The duration of stage N2 sleep was longer in the SGB group compared with the control group [28 (interquartile range, 14 to 58) to 94 (interquartile range, 69 to 113) min, P = 0.016] on the first postoperative night. There were no differences in the duration of stage N1 and N3 sleep (P = 0.180, 0.086, respectively) on the first postoperative night, and the duration of stage N1, N2 and N3 sleep (P = 0.194, 0.057, 0.405, respectively) on the second postoperative night between the groups. CONCLUSION A pre-operative SGB effectively prevented the occurrence of postoperative supraventricular tachycardias and improves the objective sleep quality in patients undergoing thoracic surgery for cancer. TRIAL REGISTRATION NUMBER ChiCTR-1900023064.

Efficacy of ultrasound-guided stellate ganglion block in relieving acute postoperative pain: a systematic review and meta-analysis

“…The trials included in the present study were published between the years 2004 and 2022, and their sample sizes ranged from 30 to 90. The trials investigated the effects of SGB in patients who underwent various kinds of surgeries: breast surgeries in three studies, 15 – 17 abdominal surgeries in two studies, 13 , 14 and upper limb and thoracoscopic surgeries in the remaining studies. 11 , 12 Five studies compared SGB with placebo, 11 , 13 , 14 , 17 , 18 and two studies compared SGB with multimodal systemic analgesia or PCA.…”

Preoperative left stellate ganglion block: Does it offer arrhythmia-protection during off-pump CABG surgery? A randomized clinical trial

“…Another study done by Wu et al and involved 90 cancer patients who had underwent thoracoscopic surgery for lung cancer and randomized into two groups; either to received SGB through ultrasonographic injection of 5 ml ropivacaine 5% or to be in the control group. They found that the incidence of supraventricular tachycardia during the postoperative 48-hour follow-up period was significantly reduced in SGB group in comparison to the control group with 11.6 (5/43) vs. 31.8% (14/44), respectively with P = 0.023 [23].…”

Effects of Ultrasound-Guided Stellate Ganglion Block on Postoperative Quality of Recovery in Patients Undergoing Breast Cancer Surgery: A Randomized Controlled Clinical Trial

“…In our study, we found that patients in the ultrasound-guided SGB group had high emotional status and physical comfort scores, similar to earlier clinical findings. In a randomized controlled clinical trial, Wu et al reported that SGB improved postoperative sleep by prolonging sleep time and improving sleep efficiency in patients with thoracoscopic surgery [ 22 ]. Similarly, Lipov et al reported that SGB led to lower postoperative Pittsburgh Sleep Quality Index scores [ 7 ] and decreased night awakenings [ 8 ].…”