Tieshuai Liu,1,* Jun Zhang,1,* Jingwen Liang,1,2,* Raojun Luo,3 Ziming Zhang,4 Jiwen Li,5 Zhichao Ai,1 Jiaqi Xiong,1 Shameera Sayer,6 Qihong Shen,7 Xin Yu,1 Gang Chen1 

1Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China; 2School of Medicine, Shaoxing University, Shaoxing, Zhejiang, People’s Republic of China; 3Department of Thoracic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China; 4Neonatal Intensive Care Unit, Children’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China; 5Department of Cardiac Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China; 6International School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China; 7Department of Anesthesiology, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Gang Chen, Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China, Tel +8613757118681, Fax +8657186044817, Email chengang120@zju.edu.cn Xin Yu, Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China, Tel +8613588708514, Fax +86057186006662, Email xinxin_yu@zju.edu.cn

Background: Postoperative atrial fibrillation (POAF) is a common complication after esophagectomy and is associated with adverse outcomes. This study investigated whether preoperative stellate ganglion block (SGB) could reduce the incidence of POAF and improve postoperative recovery.
Methods: In this single-center, randomized, double-blind, placebo-controlled trial, 100 patients undergoing esophagectomy were randomly assigned to receive ultrasound-guided right-sided SGB with 7 mL of either 0.5% ropivacaine (SGB group) or normal saline (control group). The primary outcome was the incidence of POAF within 72 hours postoperatively. Secondary outcomes included the timing and duration of POAF, heart rate variability, other arrhythmias, sufentanil consumption, pain scores, vital signs, sleep quality, gastrointestinal recovery, length of hospital stay, complications and mortality.
Results: The incidence of POAF was 10% in both groups (OR = 1.0, 95% CI: 0.27– 3.69, p > 0.99). However, patients in the SGB group experienced significantly fewer premature atrial contractions (97 vs 347; p = 0.038), lower pain scores (VAS at rest: B = – 0.60, p < 0.001; during movement: B = – 0.67, p < 0.001) and lower heart rate on postoperative day 1 (B = – 4.29, p = 0.026). Regarding gastrointestinal recovery, the SGB group showed significantly shorter times to first flatus (p = 0.001) and first semi-liquid intake (p = 0.027). Sleep disturbances were also less frequent in the SGB group (4% vs 21%, OR = 0.08, p = 0.039). No significant differences were observed between the groups in terms of length of hospital stay, incidence of postoperative complications or mortality.
Conclusion: Although SGB did not reduce the incidence of POAF, it was associated with improved postoperative recovery. These findings suggest that SGB may serve as a beneficial adjunct to optimize recovery following esophagectomy.

Keywords: postoperative atrial fibrillation, stellate ganglion block, esophagectomy, autonomic nervous system, sleep quality