Discussion
postoperative sleep disorders, postoperative incisional pain, postoperative cough, tissue injury, postoperative hoarseness, inflammation, throat, pain, intermittent claudication, PONV, Lumbar spine diseases, trauma
INFLAMMATION, COMPLICATION, DYSFUNCTION, INTERMITTENT CLAUDICATION, OXIDATIVE STRESS, INFLAMMATORY RESPONSE
Lumbar spine diseases are prevalent among middle-aged and elderly individuals in China. The primary symptoms include intermittent claudication and pain in the legs and lower back. In severe cases, these symptoms can significantly impact daily life. In clinical practice, when conservative treatments prove ineffective, surgical interventions are typically performed [During anesthesia induction, the patient needed to be in a supine position for intubation and then rotated from the supine to the prone position while still intubated. Studies have shown that more than 90% of patients experience tracheal tube displacement during the rotation process, with nearly half of them having a displacement of more than 10 mm. In addition, more than 80% of patients experience changes in tracheal cuff pressure [POST is a frequent complication after surgery that is directly linked to tracheal intubation. The pressure and friction of the laryngoscope and tracheal tube during intubation can harm the mucosal tissue of the pharynx and larynx, triggering an inflammatory response that leads to the development of POST [Research has demonstrated that postoperative sleep disorders in orthopedic surgery patients are primarily attributable to physiological and psychological factors. These factors include postoperative incisional pain, restricted physical activity, heightened mental stress, apprehension regarding inadequate postoperative recovery, and discomfort with the hospital environment [SGB, recognized by most clinical doctors for its safety and efficacy as a sympathetic nerve block, has been extensively utilized [The study results showed that both groups experienced the most significant POST within 6 h after surgery, and the incidence of POST in the SGB group was significantly lower than that in the CG at 1 h and 6 h after surgery. These findings demonstrate that SGB can effectively alleviate the discomfort and pain associated with throat intubation and enhance postoperative patient comfort. Furthermore, preoperative SGB can effectively reduce the incidence of postoperative hoarseness, but its impact on postoperative cough and PONV is minimal. Although the incidence of POST in the SGB group was slightly lower than that in the CG at 24 h and 48 h after surgery, the results were not statistically significant. This may be due to the use of corticosteroids by surgeons during surgery, which resulted in a lower incidence of POST in the CG than in previous reports [The mechanism by which SGB reduces POST may be related to the extensive distribution of stellate ganglion fibers and the blocking of excitatory conduction of the posterior sympathetic nerves in the throat and tracheal mucosa. This effect prevents sympathetic function from effectively acting on corresponding organs and tissues. Additionally, stellate ganglion block can modify the process of inflammation triggered by tissue injury, inhibit the migration of white blood cells to the inflammation site, and reduce the release of inflammatory factors. This approach can also decrease the body's inflammatory response and oxidative stress damage, thereby preserving tissue cell integrity.We collected and compared data on the levels of C-reactive protein (CRP) and interleukin-6 (IL-6) in the two groups, but found no statistically significant difference between them. These findings are inconsistent with some previous clinical trials [Optimal postoperative sleep quality can expedite patient recovery, decrease hospitalization duration, and alleviate the economic burden on patients [We did not find conclusive evidence in this study to support the hypothesis that SGB effectively alleviates perioperative pain. This finding contradicts traditional beliefs and may be because the observed postoperative incision pain was primarily caused by surgical trauma, rather than sympathetic nervous system dysfunction. However, the SGB group did exhibit a decrease in VAS scores at 48 h after surgery, possibly attributable to the anti-inflammatory effect of SGB during the wound recovery phase. One limitation of our study is that we did not measure inflammatory factors in patients again at the 48-h mark after surgery.Our study also has other limitations. The patients in this study underwent various types of surgeries and had a wide age range, but the sample size was relatively small. In future studies, we plan to include larger sample sizes and to stratify patients based on surgery type and age to better understand the effects of SGB at different levels. Certain factors were not recorded or compared in this study, such as the degree of tracheal tube displacement before and after patient position changes during surgery, and the use of fiber bronchoscopy to identify any injury or irritation to the pharynx during surgery. Additionally, the PCA configuration did not employ individualized schemes based on individual differences, which may have impacted some postoperative experimental results.