Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.04.024
Brazilian Journal of Anesthesiology
Clinical Research

Effect of ultrasound-guided right stellate ganglion block on perioperative atrial fibrillation in patients undergoing lung lobectomy: a randomized controlled trial

Efeito do bloqueio do gânglio estrelado direito guiado por ultrassom na fibrilação atrial perioperatória em pacientes submetidos a lobectomia pulmonar: estudo controlado randomizado

Ru Ouyang, Xinrui Li, Rui Wang, Qiqi Zhou, Yali Sun, Enjun Lei

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Abstract

Objective
To observe the effects of preoperative right stellate ganglion block on perioperative atrial fibrillation in patients undergoing lung lobectomy.

Methods
Two hundred patients who underwent a scheduled lobectomy were randomly divided into the S and C groups. The S group was injected with 4 mL of 0.2% ropivacaine under ultrasound guidance, and the C group did not receive stellate ganglion block. The patients underwent continuous ECG monitoring, and the incidences of atrial fibrillation and other types of arrhythmias were recorded from the start of surgery to 24 hours after surgery.

Results
The respective incidences of atrial fibrillation in the S group and the C group were 3% and 10% (p =  0.045); other atrial arrhythmias were 20% and 38% (p =  0.005); and ventricular arrhythmia were 28% and 39% (p =  0.09).

Conclusions
The results of the study indicated that preoperative right stellate ganglion block can effectively reduce the incidence of intraoperative and postoperative atrial fibrillation.

Keywords

Atrial fibrillation;  Lobectomy;  Autonomic function;  Stellate ganglion block

Resumo

Objetivo
Observar os efeitos do bloqueio do gânglio estrelado na fibrilação atrial no período perioperatório em pacientes submetidos a lobectomia pulmonar.

Método
Duzentos pacientes programados para lobectomia foram divididos aleatoriamente nos grupos S e C. O grupo S recebeu infusão de 4 mL de ropivacaína a 0,2% orientada por ultrasom e o grupo C não foi submetido a bloqueio do gânglio estrelado. Os pacientes foram submetidos à monitoração contínua de ECG, e as incidências de fibrilação atrial e outros tipos de arritmias foram registradas do início da cirurgia até 24 horas depois da cirurgia.

Resultados
As incidências de fibrilação atrial no grupo S e no grupo C foram 3% e 10%, respectivamente (p =  0,045); as de outras arritmias atriais foram 20% e 38% (p =  0,005); e de arritmias ventriculares 28% e 39% (p =  0,09).

Conclusões
Os resultados do estudo indicaram que o bloqueio do gânglio estrelado no pré-operatório pode ser efetivo na redução da incidência de fibrilação atrial nos períodos intra- e pós-operatório.

Palavras-chave

Fibrilação atrial;  Lobectomia;  Função autonômica;  Bloqueio do gânglio estrelado

References

1 Siegel R.L., Miller K.D., Jemal A. Cancer statistics, 2016. CA: A Cancer Journal for Clinicians. 66:7-30.

2 J. Ivanovic, D.E. Maziak, S. Ramzan, et al. Incidence, severity and perioperative risk factors for atrial fibrillation following pulmonary resection Interact Cardiovasc Thorac Surg., 18 (2014), pp. 340-346

3 L. Yu, B.J. Scherlag, Y. Sha, et al. Interactions between atrial electrical remodeling and autonomic remodeling: how to break the vicious cycle Heart Rhythm., 9 (2012), pp. 804-809

4 D. Amar, H. Zhang, D.H. Leung, et al. Older age is the strongest predictor of postoperative atrial fibrillation Anesthesiology., 96 (2002), pp. 352-356

5 I. Philip, C. Berroeta, I. Leblanc Perioperative challenges of atrial fibrillation Curr Opin Anaesthesiol., 27 (2014), pp. 344-352

6 R. Kailasam, C.A. Palin, C.W. Hogue, et al. Atrial fibrillation after cardiac surgery: an evidence-based approach to prevention Semin Cardiothorac Vasc Anesth., 9 (2005), pp. 77-85

7 D. Leftheriotis, P. Flevari, C. Kossyvakis, et al. Acute effects of unilateral temporary stellate ganglion block on human atrial electrophysiological properties and atrial fibrillation inducibility Heart Rhythm., 13 (2016), pp. 2111-2117

8 D.G. Katritsis Is atrial fibrillation an inflammatory disorder? Eur Heart J., 27 (2006), p. 886

9 Y.H. Kao, Y.C. Chen, C.C. Cheng, et al. Tumor necrosis factor-alpha decreases sarcoplasmic reticulum Ca2+-ATPase expressions via the promoter methylation in cardiomyocytes Crit Care Med., 38 (2010), pp. 217-222

10 J.E. Tisdale, H.A. Wroblewski, K.A. Kesler Prophylaxis of atrial fibrillation after noncardiac thoracic surgery Semin Thorac Cardiovasc Surg, 22 (2010), pp. 310-320

11 M. Simeoforidou, G. Vretzakis, M. Bareka, et al. Thoracic epidural analgesia with levobupivacaine for 6 postoperative days attenuates sympathetic activation after thoracic surgery J Cardiothorac Vasc Anesth., 25 (2011), pp. 817-823

12 A. Przybylski, J. Romanek, M. Chlebus, et al. Percutaneous stellate ganglion block as an adjunctive therapy in the treatment of incessant ventricular tachycardia Kardiol Pol., 76 (2018), pp. 1018-1020

13 P.E. Zambito, A. Talreja, S. Gundewar, et al. Severe left ventricular systolic dysfunction increases atrial fibrillation after ablation of atrial flutter Pacing Clin Electrophysiol., 28 (2005), pp. 1055-1059

14 X. Xie, R. Visweswaran, P.A. Guzman, et al. The effect of cardiac sympathetic denervation through bilateral stellate ganglionectomy on electrical properties of the heart Am J Physiol Heart Circ Physiol., 301 (2011), pp. H192-199

15 K. Puente de la Vega Costa, M.A. Gomez Perez, C. Roqueta, et al. Effects on hemodynamic variables and echocardiographic parameters after a stellate ganglion block in 15 healthy volunteers Auton Neurosci., 197 (2016), pp. 46-55

16 K. Wei, R.E. Feldmann Jr, A.K. Brascher, et al. Ultrasound-guided stellate ganglion blocks combined with pharmacological and occupational therapy in Complex Regional Pain Syndrome (CRPS): a pilot case series ad interim Pain Med., 15 (2014), pp. 2120-2127

17 M.H. Lee, K.Y. Kim, J.H. Song, et al. Minimal volume of local anesthetic required for an ultrasound-guided SGB Pain Med., 13 (2012), pp. 1381-1388

18 A. Fujiki, A. Masuda, H. Inoue Effects of unilateral stellate ganglion block on the spectral characteristics of heart rate variability Jpn Circ J., 63 (1999), pp. 854-858

19 G. Jung, B.S. Kim, K.B. Shin, et al. The optimal volume of 0.2% ropivacaine required for an ultrasound-guided stellate ganglion block Korean J Anesthesiol, 60 (2011), pp. 179-184

20 G. Vretzakis, M. Simeoforidou, K. Stamoulis, et al. Supraventricular arrhythmias after thoracotomy: is there a role for autonomic imbalance? Anesthesiol Res Pract. (2013), Article 413985

21 M. Swissa, S. Zhou, O. Paz, et al. Canine model of paroxysmal atrial fibrillation and paroxysmal atrial tachycardia Am J Physiol Heart Circ Physiol., 289 (2005), pp. H1851-1857

22 L.P. Zhang, L.P. Zhang, K. Hu The relationship between sympathetic nerve sprouting and ventricular arrhythmia after myocardial infarction Zhonghua Xin Xue Guan Bing Za Zhi., 38 (2010), pp. 1045-1047

23 Y.S. Qian, Q.Y. Zhao, S.J. Zhang, et al. Effect of alpha7nAChR mediated cholinergic anti-inflammatory pathway on inhibition of atrial fibrillation by low-level vagus nerve stimulation Zhonghua Yi Xue Za Zhi., 98 (2018), pp. 855-859

24 Y.Q. Chen, Y.Y. Xie, B. Wang, et al. Effect of stellate ganglion block on hemodynamics and stress responses during CO2-pneumoperitoneum in elderly patients J Clin Anesth., 37 (2017), pp. 149-153

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