Effect of sevoflurane combined with intercostal block on postoperative pulmonary function, opioid consumption, and stress response in lung cancer surgery patients

Abstract

Objective: To investigate the efficacy of sevoflurane combined with intercostal block in lung cancer surgery.

Methods: A retrospective analysis was conducted on 252 patients who underwent lung cancer surgery between January 2020 and December 2023. Patients were divided into two groups: the sevoflurane with intercostal block group (Group S, n = 108) and the propofol group (Group P, n = 144). Anesthesia protocols involved sevoflurane and intercostal nerve block or propofol. Postoperative pulmonary function, opioid consumption, stress response, and cognitive effects were compared between the two groups.

Results: The VAS scores were significantly lower in Group S at postoperative 2 h (1.96 ± 0.52 vs 2.15 ± 0.56, P = 0.005) and 24 h (3.84 ± 0.95 vs 4.14 ± 0.98, P = 0.015), indicating superior pain management. Group S also showed better preservation of lung function, with higher FEV1 values at postoperative 2 hours (1.49 ± 0.29 L vs 1.36 ± 0.65 L, P = 0.033) and 24 hours (1.59 ± 0.39 L vs 1.45 ± 0.45 L, P = 0.012). Opioid consumption was lower in Group S at both postoperative 24 h (1307.52 ± 259.41 µg vs 1742.26 ± 253.12 µg, P < 0.001) and 48 h. Cognitive function was better preserved immediately post-surgery in Group S (26.03 ± 4.42 vs 24.14 ± 5.28, P = 0.003). However, adverse reactions like nausea were more common in Group S (9.26% vs 2.78%, P = 0.026).

Conclusion: Sevoflurane combined with intercostal block outperforms propofol in enhancing postoperative pulmonary function, reducing opioid reliance, and modulating stress responses in lung cancer surgery patients.

Keywords: Lung cancer surgery; intercostal block; opioid consumption; pulmonary function; sevoflurane; stress response.

Figure 1

Flowchart of inclusion and exclusion.

Figure 2

Changes in lung function at 24 hours after surgery in the two groups. A1. FEV1 (L) - Preoperative; A2. FEV1 (L) - Postoperative 8 h; A3. FEV1 (L) - Postoperative 12 h; A4. FEV1 (L) - Postoperative 24 h; B1. FVC (L) - Preoperative; B2. FVC (L) - Postoperative 8 h; B3. FVC (L) - Postoperative 12 h; B4. FVC (L) - Postoperative 24 h; C1. VC (L) - Preoperative; C2. VC (L) - Postoperative 8 h; C3. VC (L) - Postoperative 12 h; C4. VC (L) - Postoperative 24 h. Note: FEV1, forced expiratory volume in 1 s; FVC, forced vital capacity; VC, Vital Capacity; ns, non-significance; *, P < 0.05; **, P < 0.01.

Figure 3

Comparison of postoperative adverse reactions between the two groups (n, %). A. Low blood pressure; B. Bradycardia; C. Nausea; D. Vomiting. Note: ns, non-significance; *, P < 0.05.