In Group S, 2 patients did not develop Horner's syndrome after SGB, 1 patient was transferred to ICU after surgery, and 2 patients failed epidural puncture. Three patients failed epidural puncture and 2 patients were transferred to ICU after surgery in Group C. Finally, 40 patients completed the study (Fig.1). There were no significant differences in the demographic data and perioperative indicators between the two groups (P > 0.05), except that the endotracheal tube removal time after operation was significantly shorter in Group S than Group C (P < 0.05) (Table 1).
Table 1. Demographics and perioperative indicators of patients in both groups
Indicators
|
Group S
|
Group C
|
P
|
Male/Female
|
12/8
|
11/9
|
0.749
|
Age (years)
|
66.65 ± 7.59
|
67.90 ± 7.14
|
0.595
|
Height (cm)
|
166.60 ± 8.95
|
164.70 ± 8.74
|
0.501
|
Body weight (kg)
|
65.75 ± 10.20
|
64.88 ± 11.03
|
0.796
|
ASA status (I/II/III)
|
6/10/4
|
5/10/5
|
0.904
|
Fluid intake (mL)
|
2225 ± 499.34
|
2275 ± 472.25
|
0.747
|
Bleeding volume (mL)
|
197.50 ± 129.24
|
207.50 ± 133.06
|
0.775
|
Urine volume (mL)
|
585 ± 319.58
|
800 ± 392.36
|
0.065
|
Anesthesia time (min)
|
262.45 ± 55.22
|
275.35 ± 66.36
|
0.508
|
Operating time (min)
|
231.55 ± 50.59
|
235.60 ± 57.42
|
0.814
|
Endotracheal tube removal time after operation (min)
|
15.80 ± 4.24
|
18.95 ± 5.38
|
0.047
|
PACU retention time (min)
|
34.65 ± 5.61
|
35.70 ± 3.99
|
0.499
|
Propofol dose (mg)
|
621.00 ± 152.62
|
662.20 ± 173.27
|
0.430
|
Sufentanil dose (μg)
|
16.95 ± 3.97
|
17.10 ± 2.65
|
0.889
|
Remifentanil dose (mg)
|
0.69 ± 0.31
|
0.72 ± 0.34
|
0.789
|
Dexmedetomidine dose (μg)
|
62.95 ± 26.99
|
62.33 ± 19.66
|
0.934
|
Length of postoperative hospital stay [d, M(Q)]
|
16(13)
|
17(13)
|
0.71
|
Values are mean±SD or number;
M(Q) median (quartile spacing); PACU post-anesthesia recovery unit.
P for comparisons between Group S and Group C.
At T1, the two groups did not significantly differ in terms of MAP and HR (P > 0.05). In Group C, MAP was significantly higher at T2, T3, and T4 than at T1 and HR was significantly higher at T2 and T3 than at T1 (P < 0.05). MAP and HR at T2, T3, and T7 were significantly lower in Group S than in Group C (P < 0.05) (Table 2).
Table 2. Changes of perioperative hemodynamics in both groups
Time
points
|
MAP
|
HR
|
Pa
|
Pb
|
Group S
|
Group C
|
Group S
|
Group C
|
T1
|
100.15 ± 6.41
|
101.35 ± 5.13
|
73.70 ± 6.51
|
73.50 ± 7.66
|
0.517
|
0.930
|
T2
|
99.10 ± 6.58
|
111.65 ± 15.52
|
76.70 ± 12.62
|
84.3 ± 8.02
|
<0.01
|
0.029
|
T3
|
97.15 ± 5.07
|
108.95 ± 8.29
|
68.55 ± 9.14
|
82.85 ± 6.04
|
<0.01
|
<0.01
|
T4
|
92.45 ± 7.72
|
93.60 ± 6.98
|
69.30 ± 5.13
|
72.30 ± 7.83
|
0.624
|
0.16
|
T5
|
94.15 ± 5.48
|
96.55 ± 7.27
|
70.4 ± 5.62
|
73.00 ± 5.09
|
0.246
|
0.134
|
T6
|
93.85 ± 9.05
|
97.05 ± 10.50
|
69.50 ± 4.83
|
74.45 ± 4.99
|
0.308
|
<0.01
|
T7
|
98.95 ± 7.05
|
105.90 ± 13.44
|
74.50 ± 8.03
|
81.55 ± 8.77
|
0.048
|
0.012
|
T8
|
94.10 ± 11.73
|
94.00 ± 12.85
|
65.15 ± 9.07
|
66.15 ± 8.29
|
0.980
|
0.718
|
PT1-2
|
>0.99
|
0.32
|
>0.99
|
<0.01
|
|
|
PT1-3
|
0.986
|
0.014
|
0.359
|
<0.01
|
|
|
PT1-4
|
0.200
|
0.018
|
0.696
|
>0.99
|
|
|
PT1-5
|
0.091
|
0.379
|
0.916
|
>0.99
|
|
|
PT1-6
|
0.405
|
0.949
|
0.414
|
>0.99
|
|
|
PT1-7
|
>0.99
|
0.983
|
>0.99
|
0.107
|
|
|
PT1-8
|
0.705
|
0.345
|
0.016
|
0.069
|
|
|
PT2-3
|
>0.99
|
>0.99
|
0.061
|
>0.99
|
|
|
PT2-4
|
0.713
|
<0.01
|
0.393
|
<0.01
|
|
|
PT2-5
|
>0.99
|
<0.01
|
0.517
|
<0.01
|
|
|
PT2-6
|
>0.99
|
<0.01
|
0.075
|
<0.01
|
|
|
PT2-7
|
>0.99
|
0.951
|
>0.99
|
>0.99
|
|
|
PT2-8
|
>0.99
|
<0.01
|
0.011
|
<0.01
|
|
|
PT3-4
|
0.801
|
<0.01
|
>0.99
|
<0.01
|
|
|
PT3-5
|
0.909
|
<0.01
|
>0.99
|
<0.01
|
|
|
PT3-6
|
>0.99
|
<0.01
|
>0.99
|
<0.01
|
|
|
PT3-7
|
>0.99
|
>0.99
|
0.632
|
>0.99
|
|
|
PT3-8
|
>0.99
|
<0.01
|
>0.99
|
<0.01
|
|
|
PT4-5
|
>0.99
|
>0.99
|
>0.99
|
>0.99
|
|
|
PT4-6
|
>0.99
|
>0.99
|
>0.99
|
>0.99
|
|
|
PT4-7
|
0.773
|
0.014
|
0.666
|
0.014
|
|
|
PT4-8
|
>0.99
|
>0.99
|
0.772
|
0.131
|
|
|
PT5-6
|
>0.99
|
>0.99
|
>0.99
|
>0.99
|
|
|
PT5-7
|
0.941
|
0.054
|
0.875
|
0.012
|
|
|
PT5-8
|
>0.99
|
>0.99
|
0.453
|
0.089
|
|
|
PT6-7
|
0.968
|
0.205
|
0.661
|
0.109
|
|
|
PT6-8
|
>0.99
|
>0.99
|
0.870
|
0.029
|
|
|
PT7-8
|
>0.99
|
0.108
|
<0.01
|
<0.01
|
|
|
Values are mean±SD.
T1, before induction of general anesthesia; T2, after tracheal intubation; T3, beginning of surgery; T4, 1 h after the beginning of surgery; T5, 2 h after the beginning of surgery; T6, the end of surgery; T7, immediately after extubation; T8, 30 min in the PACU
MAP mean arterial pressure; HR heart rate
PT1-2, PT1-3, PT1-4, PT1-5, PT1-6, PT1-7, PT1-8 for comparisons between T1 and T2, T3, T4, T5, T6, T7, T8; PT2-3, PT2-4, PT2-5, PT2-6, PT2-7, PT2-8 for comparisons between T2 and T3, T4, T5, T6, T7, T8; PT3-4, PT3-5, PT3-6, PT3-7, PT3-8 for comparisons between T3 and T4, T5, T6, T7, T8; PT4-5, PT4-6, PT4-7, PT4-8 for comparisons between T4 and T5, T6, T7, T8; PT5-6, PT5-7, PT5-8 for comparisons between T5 and T6, T7, T8; PT6-7, PT6-8 for comparisons between T6 and T7, T8; PT7-8 for comparisons between T7 and T8; Pa for comparisons MAP between group S and group C; Pb for comparisons HR between group S and group C
There were no significant differences in electrolytes including K+, Ca2+ and lactate between the two groups. The blood glucose levels were significantly higher in both groups at T5 and T6 compared with T1 (P < 0.05), higher in Group S at T6 and in Group C at T5 and T6 compared with T4 (P < 0.05), higher in both groups at T6 compared with T5 (P < 0.05), while lower in Group S at T5 and T6 compared with Group C (P < 0.05). There were no significant differences in K+, Ca2+ and LAC concentrations between the two groups at each time point (P > 0.05) (Table 3).
Table 3. Changes in K+, Ca2+ and LAC concentrations and blood glucose levels during the perioperative period in both groups
Indicators
|
Timepoints
|
Group S
|
Group C
|
P
|
K+
|
T1
|
3.84±0.17
|
3.83±0.35
|
0.936
|
|
T4
|
3.91±0.32
|
3.86±0.38
|
0.654
|
|
T5
|
3.90±0.56
|
4.09±0.36
|
0.212
|
|
T6
|
4.04±0.39
|
4.03±0.29
|
0.946
|
|
PT1-T4
|
0.828
|
>0.99
|
|
|
PT1-T5
|
>0.99
|
0.127
|
|
|
PT1-T6
|
0.061
|
0.062
|
|
|
PT4-T5
|
>0.99
|
0.307
|
|
|
PT4-T6
|
0.351
|
0.102
|
|
|
PT5-T6
|
0.784
|
>0.99
|
|
Ca2+
|
T1
|
1.11±0.06
|
1.10±0.06
|
0.906
|
|
T4
|
1.12±0.03
|
1.11±0.05
|
0.835
|
|
T5
|
1.12±0.06
|
1.14±0.07
|
0.39
|
|
T6
|
1.13±0.06
|
1.15±0.07
|
0.164
|
|
PT1-T4
|
>0.99
|
>0.99
|
|
|
PT1-T5
|
>0.99
|
0.622
|
|
|
PT1-T6
|
0.968
|
0.067
|
|
|
PT4-T5
|
>0.99
|
0.682
|
|
|
PT4-T6
|
>0.99
|
0.108
|
|
|
PT5-T6
|
>0.99
|
0.541
|
|
LAC
|
T1
|
0.75±0.26
|
0.76±0.35
|
>0.99
|
|
T4
|
0.75±0.36
|
0.69±0.49
|
0.634
|
|
T5
|
0.71±0.27
|
0.63±0.32
|
0.358
|
|
T6
|
0.72±0.33
|
0.82±0.29
|
0.320
|
|
PT1-T4
|
>0.99
|
0.784
|
|
|
PT1-T5
|
0.920
|
0.05
|
|
|
PT1-T6
|
>0.99
|
>0.99
|
|
|
PT4-T5
|
0.967
|
0.810
|
|
|
PT4-T6
|
>0.99
|
0.905
|
|
|
PT5-T6
|
>0.99
|
0.411
|
|
GLU
|
T1
|
5.9±1.0
|
5.8±1.0
|
0.69
|
|
T4
|
6.5±1.1
|
6.4±1.0
|
0.765
|
|
T5
|
7.1±1.2
|
7.8±1.2
|
0.047
|
|
T6
|
7.7±1.2
|
8.6±1.5
|
0.046
|
|
PT1-T4
|
0.101
|
0.078
|
|
|
PT1-T5
|
<0.01
|
<0.01
|
|
|
PT1-T6
|
<0.01
|
<0.01
|
|
|
PT4-T5
|
0.124
|
<0.01
|
|
|
PT4-T6
|
<0.01
|
<0.01
|
|
|
PT5-T6
|
<0.01
|
<0.01
|
|
Values are mean±SD.
T1, before induction of general anesthesia; T4, 1 h after the beginning of surgery; T5, 2 h after the beginning of surgery; T6, the end of surgery
LAC lactic acid; GLU glucose
PT1-T4, PT1-T5, PT1-T6 for comparisons between T1 and T4, T5, T6; PT4-T5, PT4-T6 for comparisons between T4 and T5, T6; PT5-T6 for comparisons between T5 and T6; P for comparisons between group S and group C
Compared with T0, IL-6 and IL-10 at T9 and T10 were significantly increased in Group S (P < 0.05), and IL-1 at T10, IL-6 and S100-β at T9 and T10 were significantly increased in Group C (P < 0.05). Significantly lower levels of IL-6 at T9, S100-β at T9 and T10, and IL-1 and IL-10 at T10 were found in Group S than Group C (P < 0.05) (Table 4).
Table 4. Changes of plasma IL-1, IL-6, IL-10 and S100-β concentrations in both groups
Indicators
|
Timepoints
|
Group S
|
Group C
|
P
|
IL-1 (pg/mL)
|
T0
|
4.86 ± 0.38
|
4.91 ± 0.25
|
0.582
|
|
T9
|
5.28 ± 1.02
|
5.57 ± 1.25
|
0.421
|
|
T10
|
5.10 ± 0.90
|
5.76 ± 1.10
|
0.043
|
|
PT0-T9
|
0.398
|
0.085
|
|
|
PT0-T10
|
0.722
|
0.005
|
|
|
PT9-T10
|
0.933
|
0.918
|
|
IL-6 (pg/mL)
|
T0
|
4.34 ± 1.34
|
4.70 ± 2.21
|
0.543
|
|
T9
|
32.63 ± 24.21
|
92.60 ± 41.39
|
<0.01
|
|
T10
|
19.87 ± 15.18
|
22.31 ± 11.78
|
0.573
|
|
PT0-T9
|
0.020
|
<0.01
|
|
|
PT0-T10
|
<0.01
|
<0.01
|
|
|
PT9-T10
|
0.227
|
<0.01
|
|
IL-10 (pg/mL)
|
T0
|
5.46 ± 0.93
|
5.16 ± 0.76
|
0.274
|
|
T9
|
34.96 ± 49.79
|
23.80 ± 44.94
|
0.461
|
|
T10
|
13.18 ± 5.26
|
7.71 ± 8.16
|
0.016
|
|
PT0-T9
|
0.024
|
0.237
|
|
|
PT0-T10
|
<0.01
|
0.28
|
|
|
PT9-T10
|
0.145
|
0.374
|
|
S100-β(ng/ml)
|
T0
|
0.057±0.009
|
0.060±0.014
|
0.49
|
|
T9
|
0.065±0.012
|
0.104±0.015
|
<0.01
|
|
T10
|
0.065±0.014
|
0.085±0.019
|
<0.01
|
|
PT0-T9
|
0.169
|
<0.01
|
|
|
PT0-T10
|
0.228
|
<0.01
|
|
|
PT9-T10
|
>0.99
|
<0.01
|
|
Values are mean±SD.
T0, 1 d before surgery; T9, 24 h after surgery; T10, 72 h after surgery
PT0-T9, PT0-T10 for comparisons between T0 and T9, T10; PT9-T10 for comparisons between T9 and T10; P for comparisons between group S and group C
In Group C, MMSE scores were significantly lower at T9, T10 and T11 compared with T0 (P < 0.05). However, there were no significant differences in MMSE scores at all time points in Group S (P > 0.05). Compared with Group C, MMSE scores were significantly higher and the incidence of POCD was significantly lower at T9 and T10 in Group S (P < 0.05) (Table 5).
Table 5. Changes of MMSE scores and incidence at each time point in both groups
Time points
|
Group S
|
Group C
|
Pa
|
Pb
|
MMSE
|
Incidence (%)
|
MMSE
|
Incidence (%)
|
T0
|
27.4±1.43
|
|
26.85±1.75
|
|
0.284
|
|
T9
|
26.95±1.84
|
1(5%)
|
25.5±1.79
|
6(30%)
|
0.016
|
0.037
|
T10
|
27.25±1.83
|
1(5%)
|
25.65±1.63
|
7(35%)
|
0.006
|
0.018
|
T11
|
27.1±1.99
|
0(0%)
|
26.05±1.84
|
2(10%)
|
0.093
|
0.147
|
T12
|
27.35±1.89
|
0(0%)
|
26.55±1.87
|
1(5%)
|
0.188
|
0.311
|
PT0-T9
|
0.172
|
|
<0.01
|
|
|
|
PT0-T10
|
>0.99
|
|
<0.01
|
|
|
|
PT0-T11
|
0.85
|
|
0.007
|
|
|
|
PT0-T12
|
>0.99
|
|
0.566
|
|
|
|
PT9-T10
|
0.404
|
|
0.978
|
|
|
|
PT9-T11
|
>0.99
|
|
0.033
|
|
|
|
PT9-T12
|
0.081
|
|
<0.01
|
|
|
|
PT10-T11
|
>0.99
|
|
0.2
|
|
|
|
PT10-T12
|
>0.99
|
|
<0.01
|
|
|
|
PT11-T12
|
0.775
|
|
0.043
|
|
|
|
Values are expressed as number (percentage) or mean±SD.
T0, 1 d before surgery; T9, 24 h after surgery; T10, 72 h after surgery; T11, 5 d postoperatively; T12, 7 d postoperatively
MMSE Mini-mental State Examination
PT0-T9, PT0-T10, PT0-T11, PT0-T12 for comparisons between T0 and T9, T10, T11, T12; PT9-T10, PT9-T11, PT9-T12 for comparisons between T9 and T10, T11, T12; PT10-T11, PT10-T12 for comparisons between T10 and T11, T12; PT11-T12 for comparisons between T11 and T12; Pa for comparisons MMSE between group S and group C; Pb for comparisons Incidence between group S and group C