Effects of ultrasound-guided subserratus anterior plane block combined with rectus sheath block on postoperative analgesia, inflammatory factors and immune function in patients undergoing laparoscopic gastric cancer surgery

Objective To evaluate the impact of ultrasound-guided subserratus anterior plane block (SAPB) in conjunction with rectus sheath block (RSB) on postoperative analgesia, inflammatory markers,and immune function in patients undergoing laparoscopic surgery for gastric cancer. Methods A total of 60 patients who underwent laparoscopic gastrectomy under general anesthesia at the First Affiliated Hospital of Hebei North University were selected and randomly assigned to two groups: Group C and Group R, with 30 patients in each group. In Group R,a bilateral low-position SAPB combined with rectus sheath block (RSB) was performed using 60 ml of 0.25% ropivacaine following the induction of general anesthesia; whereas Group C received only general anesthesia.Patients in Group C and Group R received postoperative intravenous patient-controlled analgesia (PCIA). Visual analogue scale (VAS) pain scores were assessed at various time points postoperatively for both groups. The utilization of analgesic medications during the perioperative period was compared between the two groups. Additionally, levels of inflammatory factors (IL-6, IL-8, and IL-10) as well as immune markers (CD3 ⁺ , CD4 ⁺ , CD8 ⁺ , and CD4 ⁺ /CD8 ⁺ ) were evaluated at different time intervals and analyzed comparatively between the two groups. Results Group R exhibited significantly lower VAS scores during both resting and coughing activities at time points t ₁ to t ₄ compared to Group C ( P  < 0.05). The total dosage of analgesic medications administered intraoperatively and postoperatively in Group R was significantly lower ( P  < 0.05). Relative to t ₀ , the levels of IL-6, IL-8, and IL-10 were significantly elevated at t ₄ and t ₆ in both patient groups ( P  < 0.05), Notably, the levels of IL-6 and IL-8 in Group R were significantly lower than those observed in Group C ( P  < 0.05), whereas the level of IL-10 in Group R was markedly higher than that in Group C ( P  < 0.05). Relative to t ₀ , the levels of immune function indicators CD8 ⁺ and CD4 ⁺ /CD8 ⁺ in both groups exhibited a decline at the t ₄ and t ₆ time points. ( P  < 0.05); In comparison to Group C, Group R exhibited higher levels of immune function indicators CD3 ⁺ , CD4 ⁺ , and CD8 ⁺ at t ₄ ( P  < 0.05). Additionally, the level of CD3 ⁺ in Group R was significantly elevated compared to that in Group C at t ₆ ( P  < 0.05), whereas no statistically significant differences were found for other immune function indicators between the two groups ( P  > 0.05). Conclusion Ultrasound-guided inferior Subserratus anterior plane block combined with rectus sheath block effectively alleviates postoperative pain in patients undergoing laparoscopic gastrectomy for gastric cancer, reduces the inflammatory response during the perioperative period, and promotes the recovery of immune function