Regional Anesthesia Combined With Respiratory Physiotherapy Improves Postoperative PaO₂:FiO₂ Ratio and Pulmonary Atelectasis in Thoracolaparoscopic Esophagectomy:A Randomized Controlled Trial.

OBJECTIVES

This study aimed to evaluate whether regional anesthesia combined with respiratory physiotherapy could enhance postoperative oxygenation and decrease pulmonary atelectasis after thoracolaparoscopic esophagectomy.

DESIGN

Randomized controlled trial.

SETTING

The operating room of a tertiary hospital.

PARTICIPANTS

Eighty-one patients diagnosed with esophageal cancer who were scheduled for elective thoracolaparoscopic esophagectomy.

INTERVENTIONS: Patients were randomly allocated into 3 groups: the control group (C group) received patient-controlled intravenous analgesia (PCIA) only; the regional anesthesia group (N group) received ultrasound-guided serratus anterior plane block combined with bilateral rectus abdominis sheath block and transversus abdominis plane block, plus PCIA; and the regional anesthesia combined with respiratory physiotherapy group (ND group) received the same regional blocks as the N group, followed by a structured respiratory physiotherapy protocol (including lateral rotation, manual hyperinflation, chest percussion, and suctioning) before extubation in the postanesthesia care unit, plus PCIA.

MEASUREMENTS AND MAIN

RESULTS

The primary outcome was the PaO₂:FiO₂ ratio. Secondary outcomes included lung ultrasound scores, incidence of postoperative pulmonary complications, and recovery parameters. At 24 hours postoperatively, the PaO₂:FiO₂ ratio was significantly higher in the ND group than in both the C and N groups (p < 0.05). Overall lung ultrasound scores were significantly lower in the ND group than in the C and N groups at both 1 and 24 hours postoperatively (p < 0.05). The incidence of pulmonary atelectasis was significantly lower in the ND group (37.0%) than in the N (88.8%) and C (100.0%) groups (p < 0.01). The ND group also had the lowest rates of respiratory failure and unplanned reintubation compared with the other 2 groups (p < 0.05). Further, the ND group had the shortest hospital stay among the 3 groups (p < 0.05).

CONCLUSIONS

Regional anesthesia combined with respiratory physiotherapy significantly improved the PaO₂:FiO₂ ratio, reduced pulmonary atelectasis, and accelerated postoperative recovery after thoracolaparoscopic esophagectomy.