| Partâ… Safety and efficacy of transversus abdominis plane block of ropivacaine in liver surgery perioperative analgesiaObjective:Study the safety and efficacy of transversus abdominis plane block of ropivacaine in liver surgery perioperative analgesiaMethod:A total of 80 liver surgery patients were include in this study, age 40 to 60 years, ASAâ… -â…¢, were randomly divided into observation group and control group. Ultrasound-guided bilateral subcostal transversus abdominis plane block was performed preoperative in two groups. The control group with normal saline 20ml, Observation group with 0.375% ropivacaine 20ml, Recorded opioid dosage in and after operation, recorded the VAS score, NRs score, Ramsay score, nausea and vomiting scores postoperation, recorded PCIA pressing times, nausea, vomiting, itching and respiratory depression incidenceResult:Compared with the control group, the observation group blood pressure fluctuations in the smaller (P<0.05) 3 min (T2),5min (T3) after the operation begin, intraoperative sufentanil consumption less (P< 0.05). postoperation the time pull tube shorter (P< 0.05). Observation group VAS score decreased significantly (P<0.05) when leave PACU and 4 hours postoperation, analgesia sufentanil consumption have significant differences (P<0.05) when leave PACU and 4 hours postoperation. The number of nausea occurred 12h postoperation fluctuation of MBP 24h postoperation, and the difference of SpO24h,48h postoperation in the two groups,were significantly different (P<0.05), the number of vomiting, itching, dizziness was no significant difference between two groups (P>0.05), Ramsay sedation score of observation group was more stable than control group and has significant statistical difference (P<0.05). The two groups were no adverse reaction caused by the puncture of transversus abdominis plane blockConclusion:Ultrasound-guided bilateral subcostal TAP block can effectively relieve opioids dosage,reduce pain score and the incidence rate of side effect postoperative. Meanwhile not found local anesthetics toxic reaction. So ultrasound-guided bilateral subcostal TAP block is safty and efficacy for liver surgery perioperative analgesia, which can be used as one effective methods of perioperative multimodal analgesiaPartâ…¡Study ropivacaine plasma concentrations of jaundice patients with transversus abdominis plane block in liver surgeryObjectiveStudy the change of ropivacaine plasma concentrations of jaundice patients with transversus abdominis plane block in liver surgeryMethodA total of 36 liver surgery patients were include in this study, age 40 to 60 years, ASA â… -â…¢, were divided into 2 groups basis on total bilirubin before operation:normal total bilirubin group (N group) and abnormal total bilirubin group (group A). Preoperative two groups of patients were respectively implemented with ultrasonic guide bilateral costal TAP block. Intraoperative collected blood samples at different time points. Postoperative centrifugal separation and save. Unified testing of plasma concentration of ropivacaine after specimen collection. At the same time, record the amount of liquid during operation,and local anesthetics toxic reaction after block.ResultIn the two groups change of ropivacaine plasma concentrations were similar. Compared with the base value, the plasma concentrations ratchet up and reach the peak plasma concentration 30 minutes after TAP block,then gradually reduce. Compared between two groups, the difference was not significant statistical difference in different time point. In the two groups change trend of net input was similar in different time point, net input increase with time. Compared between two groups, the difference of net input was not significant statistical difference in different time. Ropivacaine plasma concentration of two groups patients all did not appear to or higher than that reported in the literature poisoning dose, and we did not observe the clinical signs probably related to local anesthetic intoxation.ConclusionUltrasound-guided bilateral subcostal TAP block with 0.375% ropivacaine was used in liver surgery patients with jaundice, Local anesthetics metabolism was not slowed down obviously, blood concentration was similar to normal liver function and did not found local anesthetic related toxicity. Safe. Can be used safely for clinical analgesia in patients with jaundice... |
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