Ultrasound-guided Stellate Ganglion Block Improves Gastrointestinal Function After Thoracolumbar Spinal Surgery
Introduction
Thoracolumbar spinal surgery is a frequent procedure undertaken for patients with spinal trauma, tumor, or degeneration. In the perioperative phase, 36% to 78% of patients have gastrointestinal morbidity, including emesis, bowel irritation, abdominal bloating, constipation, and even paralytic ileus.1, 2, 3, 4, 5 These complications are possibly attributable to the imbalance between the sympathetic and parasympathetic systems after trauma and surgical manipulations.5, 6 In addition, immobilization and use of opioids and narcotics may account for bowel dysfunction.7 The most commonly used opioids include morphine, fentanyl, sufentanil, tramadol, and meperidine, which are administered on request or with a patient-controlled device. More recently, some adjunctive medications, such as dexmedetomidine and neuroblocking techniques, have been introduced to enhance postoperative analgesia and to diminish the adverse effects of opioids.8, 9, 10, 11 Most often, the treatment of this dysfunction is conservative, including early mobilization, reduction in opioid use, bowel rest, and nasogastric tube placement; however, the effects are sometimes limited.
Stellate ganglion block (SGB), a cervical sympathetic blockade, has been used since the mid-1930s. A well-developed and effective procedure, SGB is used for the treatment of a variety of medical conditions, such as angina pectoris, cardiac arrhythmias, bronchial asthma, dysmenorrhea, primary hypertension, scleroderma, vascular headache, and chronic neuropathic pain.12, 13, 14, 15, 16, 17, 18 In addition, studies have found that SGB regulates multiple systemic functions, including gastrointestinal function, possibly by regulating the autonomic and immune systems.19, 20 Compared with the landmark-guided technique, the ultrasound-guided technique has made the block more precise and effective, with a small volume of injection and improved tolerability, by direct visualization and reduction in the risk of esophageal, vascular, or neuronal injury.13, 21, 22
Despite the above-mentioned benefits, the contribution of SGB in improving postoperative bowel function has never been evaluated. We hypothesized that ultrasound-guided SGB could enhance gastrointestinal recovery after thoracolumbar spinal surgery. The primary outcome of this study was postoperative gastrointestinal function, including variables of bowel sound auscultation, incidence and degree of abdominal bloating, flatus time, and paralytic ileus.
Section snippets
Methods
This prospective, randomized, double-blind, controlled study was approved by our institutional review board and registered at www.chictr.org.cn (ChiCTR-TRC-14004289). All participants provided written informed consent. Patients with American Society of Anesthesiologists physical status I to II who were aged 18 to 70 years and had a thoracolumbar fracture scheduled for surgical treatment were recruited. Exclusion criteria were American Society of Anesthesiologists physical status III or more,
Results
Forty-four patients were randomized in this study. Four patients were withdrawn: patient-controlled analgesia medication was terminated early in 3 patients, and the surgical procedure was switched in the other patient, leaving 20 patients in each group for final analysis (Figure 1).
Table I gives the patient and surgical characteristics. There were no significant differences between the groups with regard to hemodynamic parameters or verbal rating scale pain scores (Figure 2 and Table II). As
Discussion
This double-blind randomized controlled trial of preoperative, ultrasound-guided, right-sided SGB found improved bowel function after thoracolumbar spine surgery, which was also associated with improved patient satisfaction. To our knowledge, this is the first study to evaluate the benefits of the SGB in terms of postoperative bowel function.
The sympathetic nervous system, which derives from the nucleus ceruleus of the brainstem, plays an important role in the interaction of the neural and
Conclusions
For a group of patients undergoing thoracolumbar spinal surgery, ultrasound-guided SGB improved postoperative gastrointestinal function and patient satisfaction by accelerating the return of bowel movement and reducing abdominal bloating after surgery.
Funding Sources
This work was supported in part by grants 81471835 and 81671880 (Dr. Ji), 81601666 (Dr. Zhang), and 81601659 (Dr. Peng) from the National Natural Science Foundation of China.
ConflictS of interest
The authors have indicated that they have no conflicts of interest regarding the content of this article.
Acknowledgments
We thank the surgical teams for technical help and the nurses at the Department of Anesthesiology and Orthopedics, First Affiliated Hospital of Soochow University, Suzhou, China, for helpful assistance. We thank Medjaden Bioscience Ltd for assisting in the preparation of the manuscript.
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Ultrasound-guided stellate ganglion block alleviates stress responses and promotes recovery of gastrointestinal function in patients
2021, Digestive and Liver DiseaseCitation Excerpt :These effects were not outcomes of different surgical procedures as no statistical significances were found in terms of operation time, blood loss, as well as MAP and HR values at various time points before, during and after the procedures. The role of SGB in improving gastrointestinal function has been demonstrated in spinal and abdominal surgeries [12,13]. But to our best knowledge, our study for the first time demonstrated the clinical efficacy of SGB in reducing gastrointestinal function in colorectal patients undergoing laparoscopic surgery.