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| Effect of ultrasound-guided quadratus lumborum block combined with general anesthesia on early postoperative cognitive function and stress response in elderly patients with colorectal cancer |
| MOU Junying1 LIU Tao2 YE Gang1 ZHU Xianlin1 |
| 1.Department of Western Medicine Anesthesiology, the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Hubei Province, Enshi 445000, China; 2.Department of Hepatobiliary Surgery, the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Hubei Province, Enshi 445000, China |
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Abstract Objective To evaluate the effect of ultrasound-guided quadratus lumborum block (QLB) combined with general anesthesia on early postoperative cognitive function and stress response in elderly patients with colorectal cancer. Methods From July 2018 to July 2019, 60 cases with open colorectal cancer surgery in the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture were collected. They were divided into ultrasound-guided QLB combined with general anesthesia group (group T) and general anesthesia group (group C) according to the radom number table method, with 30 cases in each group. Group T patients were guided by ultrasound to bilateral QLB before surgery, and anesthesia induction began after block for 20 min. Group C was injected with the same normal saline. Mean arterial pressure (MAP), heart rate (HR), blood glucose (Glu) and C-reaction protein (CRP) levels were recorded and compared at 10 min after the patient entered the operating room (T1), 5 min after anesthesia induction (T2), 5 min after incision (T3), 2 h after incision (T4), and at the end of surgery (T5). BIS was measured at 8 o′clock on the night of operation and 6 o′clock in the morning of the next day. Deep sleep time (BIS<80) and effective sleep index (SEI) were recorded and compared between the two groups. Visual analogue scores (VAS) 24 and 48 h after surgery, postoperative cognitive dysfunction (POCD) cases on the first and third day after surgery, dosages of Sufentanil and cases of nausea and vomiting were recorded and compared. Mini-mental state examination (MMSE) and montreal cognitive assessment scale (MoCA) were recorded and compared at preoperative 1 d (Ta), postoperative 1 d (Tb), postoperative 3 d (Tc) and postoperative 5 d (Td). Results The number of cases of POCD on the first day after surgery, nausea and vomiting, postoperative Sufentanil dosages and 24 h VAS scores after surgery in group T were lower than those in group C, with statistically significant differences (all P < 0.05). There were no significant differences between the two groups in the number of cases of POCD on the third day after surgery and 48 h VAS scores after surgery (P > 0.05). BIS values in group T were lower than those in group C at 8 o′clock in the evening and 6 o′clock in the morning of the next day and SEI values in group T were higher than those in group C, the deep sleep time was longer than that in group C, with statistically significant differences (all P < 0.05). Tb MMSE and MoCA scores in group T were lower than those in group C, and Tc MMSE scores were lower than those in group C, with statistically significant differences (all P < 0.05). T3-T5 MAP in group T were lower than those in group C, and T3, T5 HR were lower than those in group C, with statistically significant differences (all P < 0.05). The levels of T3-T5 Glu in group T were lower than those in group C, and the levels of T2 CRP were lower than those in group C, with statistically significant differences (all P < 0.05). Conclusion Ultrasound-guided QLB combined with general anesthesia can reduce perioperative stress response, and decrease the incidence of early POCD in elderly patients with colorectal cancer.
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