The Effect of a Combined Modified Pectoral and Stellate Ganglion Block on Stress and Inflammatory Response in Patients Undergoing Modified Radical

Abstract

\n Background: Surgical resection is the primary and most effective method for removing breast tumors, but it is associated with significant stress and inflammatory responses. Previous studies have indicated that these responses can be influenced by anesthetic method. While regional anesthesia has been shown to attenuate stress and inflammatory responses associated with surgical procedure, the effectiveness of combined nerve blocks has not been investigated. Therefore, we conducted this study to evaluate whether the combination of a pectoral nerve block (PNB) and stellate ganglion block (SGB) is more effective than a PNB alone in reducing stress and inflammatory responses in women undergoing modified radical mastectomy.Methods: A total of 50 breast cancer patients with American Society of Anesthesiologists physical status I or II were enrolled and randomly allocated to receive either a (1) preoperative ultrasound-guided PNB (20 mL of 0.375% ropivacaine) only (control group, n = 25) or (2) ultrasound-guided PNB (20 mL of 0.375% ropivacaine) combined with a SGB (5 mL of 0.15% ropivacaine) (SGB group, n = 25). The primary outcome was neuroendocrine levels at different time points during the 72-hour postoperative period. Assessed neuroendocrine variables included cortisol, glucose, interleukin (IL)-6, interleukin (IL)-8, and tumor necrosis factor (TNF)-a. Secondary outcomes included pain scores, hemodynamic variables, sleep quality on the night of surgery, and side effects after surgery.Results: A total of 50 patients completed the study. Cortisol levels were significantly lower in the SGB group compared to the control group at the end of the surgery. Glucose levels at the time of incision were lower in the SGB group than in the control group. The SGB group exhibited significantly lower IL-6 and TNF-a levels compared to the control group at 24 hours post-surgery. There was no significant difference in perioperative IL-10 levels between the two groups. Pain scores up to 12 hours postoperatively were significantly lower in the SGB group, which also exhibited better perioperative hemodynamic stability. Patients in the SGB group reported a better sleep quality on the night of the operation than those in the control group. No side effects were observed in either group.Conclusions: In patients undergoing a modified radical mastectomy, the combination of a SGB and PNB can more effectively blunt perioperative stress and inflammatory responses, as well as postoperative acute pain, compared to a PNB alone. A combined block approach also results in more stable perioperative hemodynamics and a better postoperative sleep quality.