Research On The Value Of Applying Multimodal Analgesia After Hepatolithiasis Surgery

Background:Enhanced recovery after surgery( ERAS)was first proposed by Henrik Kehlet,Professor at the University of Copenhagen, Denmark,in the late 1990 s.It means using effective perioperative measures, proven by evidence-based medicine, then optimizing and combining the measures, so as to achieve the reduction of surgical stress, maintain the stability of the patient environment, accelerate postoperative rehabilitation and shorten hospital stay. After years of development, the ERAS concept is gradually accepted by physicians at home and abroad, and widely used in gastrointestinal, orthopedics fields, cardiothoracic surgery, obstetrics and gynecology, urology and so on, and it have achieved good returns.Hepatolithiasis in our country is a common and frequently-occurring disease, however the clinical management of hepatolithiasis are often complex and with lots of complications,so perioperative management is particularly important. It is worth further study whether it is beneficial in application of multimodal analgesia promoted by ERAS for hepatolithiasis surgery.ObjectiveTo discuss the efficacy and safety of applying multimodal analgesia after hepatolithiasis surgery,so as to provide a scientific basis for the multimodal analgesia scheme and promote it.MethodsPatients were divided into ERAS group(40 cases) and conventional group(40 cases), patients in ERAS group received the multimodal analgesia after surgery, while patients in control group underwent the conventional way.We compared the pain scores, the C-reactive protein and insulin resistance index of the two groups, and compared the first postoperative ambulation time, exhaust defecation time, hospitalization time, cost of hospitalization, complications after surgery and so on.ResultsA total of 72 patients completed the trial, 35 cases in ERAS group undergoing multimodal analgesia and 37 cases in conventional group.Compared with conventional group,the ERAS group postoperative pain score was significantly lower(P <0.05),patients postoperative C-reactive protein was lower(P <0.05), insulin resistance was significantly reduced(P <0.05),first ambulation, exhaust defecation time was significantly earlier(P <0.05), shorter postoperative hospital stay(P <0.05), hospitalization expenses decreased(P <0.05), nausea, bloating, urinary retention incidence was lower than the traditional group, there was significant difference(P <0.05), no difference between the rest of the postoperative complications incidence(P> 0.05).Conclusion1?The multimodal analgesia of ERAS is safe and effective for patients after hepatolithiasis surgery;2?The multimodal analgesia of ERAS(sufentanil PCIA + parecoxib) we used can achieve effective postoperative analgesia,so as to reduce patients stress response, insulin resistance, shorten time of patient recovery of gastrointestinal function, as well as reduce the number of days of hospitalization and hospital costs;3?The multimodal analgesia can effectively reduce some postoperative complications;4?The multimodal analgesia can effectively increase patient's compliance to treatment, increase satisfaction.It is worthy of further promotion in clinical.