The Postoperative Clinical Observation Of Multimodal Analgesia In Gynecological Laparoscopy

Objective:To evaluate the analgesic effect of four multimodal analgesic methods in patients under-going gynecological laparoscopic operation,and to seek a perfect multimodal analgesic technique.Methods:Using the method of random number table,100 ASA I or II patients,aged 30~55 years old,body mass index 18 ~ 25,planned to undergo selective laparoscopic myomectomy applied with general anesthesia,were divided into four groups(n=25).Group A was treated with local anesthesia with 0.5% ropivacaine hydrochloride and patient controlled intravenous analgesia after operation;B group before anesthesia ultrasound-guided bilateral transversus abdominis plane block(transversus abdominis plane block,TAPB)of 0.5% ropivacaine hydrochloride 40ml+ PCIA;C group was treated with bilateral TAPB with 0.5% ropivacaine hydrochloride combined with dexmedetomidine hydrochloride 0.5mg/kg 40ml+ PCIA;D group as the control group only PCIA.After the patient enters the operation room,routine monitoring and oxygen inhalation.Each patient of the four group was induced by intravenous injection of midazolam0.05mg/kg,etomidate0.3mg/kg,sufentanil 0.4mg/kg,vecuronium 0.1mg/kg,a 3min later they were tracheal intubated,and began to mechanical volume ventilate,(approximate tidal volume of 6ml / kg,respiratory rate 14 times / min approximately,respiratory ratio(I:E)for 1:2,oxygen flow rate 2L/min,the oxygen concentration of 60%.)All patients were given general-anesthesia of propofol(target controlled infusion TCI effect site target concentration 4mg/ml,continuous intravenous infusion of remifentanil(4-12mg/kg/h),and the intraoperative additional vecuronium to maintain bispectral index(BIS)during operation from 40 to 55.Each patient was injected intravenously with tropisetron 5mg and flurbiprofen axetil 50 mg 20min before the operation was finished.All patients were given PCIA with(sufentanil 100ug+ flurbiprofen 200mg+0.9% sodium chloride to 100ml)setting the pump speed 2ml/h,loading dose 4 ml and single dose 0.5 ml.At the times of extubation(T0),1h(T1),2h(T2),4h(T4),6h(T6),8h(T8),12h(T12),18h(T18),24h(T24),36h(T36)and 48h(T48),mean arterial pressure(MAP)?visual analogue scale(VAS)? nausea and vomiting times?the times of PCIA pumping and dosage of analgesic were recorded.Results:1.MAP resultsMAP multivariate analysis of variance showed that there was statistical difference between the 11 measurements of MAP,and the interaction of the two groups were statistically significant.The analysis of the change trend of MAP repeated measurements showed that the final fitting model should be linear model.The analysis of variance between the 4 groups showed that there was no significant difference groups,age and BMI to MAP.In the four groups,the fluctuation of MAP in the 24 h group from high to low order was D > A > B > C from high to low order,the MAP volatility is basically identical within 24-48 h after surgery.2.The VAS of the four groupsCompared with D group,the VAS of A group was lower at T1(P < 0.05)after extubation;At T1? T2?T4 and T6 the VAS of B group was lower(P < 0.001),and at T8 the VAS of B was also lower(P<0.01);The VAS in group C was decreased at T4?T6?T8?T12?T18?T24 and T36(P < 0.001),at T1 and T48 the VAS was reduced(P<0.05),and the VAS was also lower at T2(P<0.1).3.The total dosage of postoperative analgesic use in the four groupsCompared with group D,in group A the total amount of analgesics was lower 1h after operation(P<0.001),The total amount of analgesics used was reduced 6 and 24 hours after surgery(P < 0.05),And the total was lower in 8 hours after surgery too(P < 0.01);In group B The total amount of analgesics used was lower at 1?6 and 24 hours after operation(P<0.001),the total was decreased 2 hours after operation(P<0.01),and the total also declined 4and 12 hours after surgery(P<0.05);And in group C 1?6?8?12?T18?24 and 36 hours after operation the total of analgesics used also declined obviously(P<0.001),2 hours after surgery the total was lower(P<0.01),and the total was reduced 4 hours after surgery(P<0.05).4.Results of patients with postoperative nausea and vomiting in the four groupsIn A,B and D groups,there were 8 cases of patients with postoperative nausea and vomiting in every group,and there were 7cases in group C.There was no significant difference among the four groups in postoperative nausea and vomiting(P>0.05).5.Results of patients with postoperative analgesia pump pressing frequency in four groupsCompared with group D,pressing pump times decreased significantly(P < 0.001)in 24 hs after extubation,fewer in 18 hs and 36hs(P < 0.01)and fewer in 12hs(P < 0.05)of group A.of group B in 24 hs pressing pump times decreased significantly(P < 0.001),while in 4hs,18 hs and 36 hs fewer(P < 0.01)and fewer press in 6hs(P < 0.05).Of group C,in 6hs?8hs? 12hs?18hs and 24 hs press pump times decreased significantly(P < 0.001)and fewer in 4hs(P < 0.05).Conclusion:The methods of the four groups all can relieve postoperative pain,but the effect of C group is the best.TAPB of 0.5% ropivacaine hydrochloride combined dexmedetomidine hydrochloride 0.5mg/kg 40 ml and PCIA of the multimodal analgesia method can provide effective postoperative analgesia and postoperative blood pressure effect.