The effects of regional anesthesia combined with awake delayed extubation in patients undergoing esophageal cancer surgery: a single-blind randomized controlled trial

Abstract

Objective: Postoperative pulmonary complications (PPCs) are the most frequent complications after esophagectomy, which usually causes to hypoxemia. The aim of this study is to evaluate whether regional anesthesia combined with awake delayed extubation improves postoperative oxygenation index after esophagectomy. Methods: Ninety patients diagnosed with esophageal cancer undergoing elective thoracolaparoscopic esophagectomy were randomized to three groups, control group (C group), regional anesthesia group (N group) and regional anesthesia combined with awake delayed extubation group (ND group). Regional anesthesia included serratus anterior plane block, transversus abdominis plane block, and rectus abdominis sheath block. Awake delayed extubation was defined as removing the endotracheal tube 30 min after waking up. The primary outcome was postoperative oxygenation index; secondary outcomes were the incidence of PPCs, analgesics consumption, postoperative pain scores, time to first flatus, time to first defecation, and hospital stays. Results: The oxygenation index of ND group was significantly higher than the N group（P＜0.05) and C group（P<0.05) at 1 hour and 24 hours postoperatively. The incidence of PPCs was significantly lower in the ND group than in the N group and C group (61.5% vs.51.8% vs. 25.9%, p = 0.026*). Conclusion: Regional anesthesia combined with awake delayed extubation can significantly improve postoperative oxygenation index, reduce the incidence of PPCs, and promote patient recovery after thoracolaparoscopic esophageal cancer surgery. Trial registration: The study was registered on Chinese Clinical Trial Registry, (ChiCTR2200066726) on 12/05/2023.