Effect of stellate ganglion block on hemodynamics and stress responses during CO2-pneumoperitoneum in elderly patients

Abstract

Study objective: Elderly patients undergoing elective laparoscopic cholecystectomy (LC) were given right stellate ganglion block (RSGB) to observe its effects on the hemodynamics and stress response during carbon dioxide (CO₂)-pneumoperitoneum.

Design: A randomized, single-blinded, and placebo-controlled study.

Setting: University-affiliated teaching hospital.

Participants: Sixty patients (aged 65-78years; weight, 45-75kg; American Society of Anesthesiologists (ASA) physical status classification, class I or II) undergoing elective LC.

Interventions: Right stellate ganglion block was performed via C7 access using 10mL of 1% lidocaine in all patients.

Measurements: The patients' heart rate (HR) and mean arterial pressure (MAP) were recorded before the block (T₀), 5min following pneumoperitoneum (T₁), 30min following pneumoperitoneum (T₂), 5min following the deflation of pneumoperitoneum (T₃), and upon completion of the surgery (T₄). Additionally, the concentrations of epinephrine (E), norepinephrine (NE) and cortisol (COR) were detected in arterial blood at each time point by enzyme-linked immunosorbent assay.

Main results: For control group, the MAP and RPP (RPP=SBP×HR) were significantly elevated at T_1~3 (P<0.05) as compared to T₀. Inter-group comparison showed that the MAP, HR and RPP were significantly lower at T_1~4 in RSGB group (P<0.05 or 0.01). As compared to T₀, the E, NE and COR levels significantly rose at T_1~4 in control group (P<0.05 or 0.01) and COR at T_{2, 3} in RSGB group (P<0.05). The E, NE and COR levels at T_1~4 were significantly lower in RSGB group as compared to control group (P<0.05 or 0.01).

Conclusion: Right stellate ganglion block can reduce blood catecholamines during CO₂-pneumoperitoneum to maintain perioperative hemodynamic stability and prevent adverse cardiovascular events in elderly patients.

Keywords: Block; Carbon dioxide-pneumoperitoneum; Elderly patients; Hemodynamics; Stellate ganglion; Stress response.