Effect of ultrasound-guided stellate ganglion block on inflammatory cytokines and postoperative recovery after partial hepatectomy: a randomised clinical trial

Abstract

Background: Stellate ganglion block (SGB) has been shown to reduce perioperative complications in various surgeries. Because laparoscopic techniques and instruments have advanced during the past two decades, laparoscopic liver resection is being increasingly adopted worldwide. Lesser blood loss, fewer postoperative complications, and shorter postoperative hospital stays are the advantages of laparoscopic liver resection, as compared to conventional open surgery. There is an urgent need for an effective intervention to reduce perioperative complications and accelerate postoperative recovery. This study investigated the effect of ultrasound-guided SGB on enhanced recovery after laparoscopic partial hepatectomy.

Methods: We compared patients who received SGB with 0.5% ropivacaine (group S) with those who received SGB with 0.9% saline (group N). A total of 58 patients with partial hepatectomy were enrolled (30 S) and (28 N). Before induction of anesthesia, SGB was performed with 0.5% ropivacaine in group S and 0.9% saline in group N.

Main outcome: Comparison of serum inflammatory cytokines concentration at each time point.

Results: Main outcome: When comparing IL-6 and IL-10 concentrations among groups, group S showed less variation over time compared to group N. For comparison between groups, the serum IL-6 concentration in group S was lower than that in group N at 6 and 24 h after operation (P < 0.01), and there was a significant linear relationship between serum IL-6 concentration at 24 h after operation and hospitalization situation.

Conclusions: Ultrasound-guided SGB can stabilize perioperative inflammatory cytokines plays a positive role in the enhanced recovery of patients after laparoscopic partial hepatectomy. The serum IL-6 level within 24 h after surgery may be used as a predictor of hospitalization.

Trial registration: The study was registered at the ClinicalTrials.gov (Registration date: 13/09/2021; Trial ID: NCT05042583).

Keywords: Enhanced recovery after surgery (ERAS); Inflammatory cytokines; Partial hepatectomy; Stellate ganglion; Ultrasound guidance.

Fig. 1

CONSORT flow diagram of participants in the study

Fig. 2

(a) Box line scatter diagram of the concentration change of IL-6 in the group S and group N at each time point; (b) Box line scatter diagram of the concentration change of IL-10 in group S and group N at each time point (The box is the quartile separation, the ends of the extension line are the maximum and minimum values, and the scatter points are the distribution of the data) a: There is statistical difference with before block; b: There was a statistical difference with 1 h after the operation; c: There was a statistical difference with 3 h after the operation; d: There was a statistical difference with 6 h after the operation; e: There was a statistical difference with 24 h after the operation started; *: There is a statistical difference between group S and group N (P < 0.05)

Fig. 3

(a) Trend plot of mean arterial pressure (MAP) in group S and group N at each time points; (b) Trend plot of heart rate in group S and group N at each time points (The center point is the mean, and the two ends of the extension line are standard deviations)

Fig. 4

(a) Histogram of comparison of length of stay (calculated from the day of operation) between Group S and Group N (expressed as average and standard deviation); (b) Box line scatter diagram of comparison of hospitalization costs (calculated from the day of operation) between Group S and Group N (The box is the quartile separation, the ends of the extension line are the maximum and minimum values, and the scatter points are the distribution of the data)

Fig. 5

(a) Correlation between length of stay (calculated from the day of operation) and IL-6 concentration at T4; (b) Correlation between hospitalization expenses (calculated from the day of operation) and IL-6 concentration at T4 (n = 58, dotted line is 95% confidence interval)