Stellate Ganglion Block Improves Postoperative Sleep Quality and Analgesia in Patients with Breast Cancer: A Randomized Controlled Trial

Abstract

Introduction: Postoperative impaired sleep quality and pain are associated with adverse outcomes. Stellate ganglion block (SGB) has shown promising results in enhancing sleep quality and alleviating neuropathic pain. This study aimed to investigate the effects of ultrasound-guided SGB on postoperative sleep quality and pain in patients undergoing breast cancer surgery.

Methods: This study is a parallel-group randomized controlled clinical trial with two groups: SGB and control. Fifty female patients undergoing breast cancer surgery were randomized in a 1:1 ratio to receive preoperative ultrasound-guided single-injection SGB (SGB group) or just an ultrasound scan (control group). All participants were blinded to the group assignment. The primary outcome was postoperative sleep quality, assessed by the St. Mary's Hospital Sleep Questionnaire and actigraphy 2 days postoperatively. The secondary outcome was postoperative pain, measured by the visual analog scale.

Results: A total of 48 patients completed the study, with 23 patients in the control group and 25 in the SGB group. The postoperative St. Mary's Hospital Sleep Questionnaire scores were significantly higher in the SGB group than in the control group on 1 day postoperative (30.88 ± 2.44 versus 27.35 ± 4.12 points, P = 0.001). The SGB also increased the total sleep time and sleep efficiency (main actigraphy indicators) during the first two postoperative nights. Compared with the control group, preoperative SGB reduced postoperative pain and the incidence of breast cancer-related lymphedema (20% versus 52.2%, P = 0.02, odds ratio 0.229, 95% confidence interval 0.064-0.821). There were no adverse events related to SGB.

Conclusion: Preoperative ultrasound-guided SGB improves postoperative sleep quality and analgesia in patients undergoing breast cancer surgery. SGB may be a safe and practical treatment to enhance the postoperative quality of life in patients with breast cancer.

Trial registration: The study was registered in the Chinese Clinical Trial Registry (ChiCTR2100046620, principal investigator: Kai Zeng, date of registration: 23 May 2021).

Keywords: Breast cancer; Postoperative pain; Sleep; Stellate ganglion block.

Fig. 1

CONSORT diagram of study flow

Fig. 2

The SMHSQ (A) and actigraphy (B–F) performance from 1 day preoperative to 1 day postoperative in the control and SGB group. SMHSQ St. Mary’s hospital sleep questionnaire, SGB stellate ganglion block, D1 1 day preoperative, D2 surgery day, D3 1 day postoperative

Fig. 3

Correlation analysis of SMHSQ and actigraphy indicators. SMHSQ, St. Mary’s hospital sleep questionnaire, SE sleep efficiency, SOL sleep onset latency, TST total sleep time, NA number of awakenings, WASO wake after sleep onset; *P < 0.05, **P < 0.01

Fig. 4

VAS pain scores at postoperative 6, 24, and 48 h in the control group and SGB group. SGB stellate ganglion block, VAS visual analog scale

Fig. 5

Concentrations of serological indicators at preoperative and 24 h postoperative in the control group (black circles) and SGB group (blue squares). SGB stellate ganglion block, T1 preoperative, T2 24 h postoperative

Fig. 6

Sleep performances of the contralateral and ipsilateral sides from 1 day preoperative to 1 day postoperative in the SGB group. SMHSQ St. Mary’s Hospital Sleep Questionnaire, SGB stellate ganglion block, D1 1 day preoperative, D2 surgery day, D3 1 day postoperative