The Analgesic Effect And Significance Of Nabuphine Combined With Transverse Abdominis Plane Block On Hepatic Carcinoma Resection

Objective:To investigate the effects of multimode analgesia of nabuphine combined with transverse abdominis plane(TAP)block on postoperative immune functions in patients of hepatocellular carcinoma(HCC).Methods:120 Hepatic Carcinoma patients undergoing elective liver resection were randomly divided into three groups.Patient controlled intravenous analgesia(PCIA)were used for patients in group C postoperatively and the formula consists of sufentanil(2ug/kg)and ondansetron(16mg)which were diluted to 100ml.Patients in group T were treated with TAP block before abdominal closure,then PCIA was used after surgery.Patients in group N were treated with TAP block and PCIA was used postoperatively which the formula consists of nabuphine(2mg/kg)and ondansetron(16mg).Patients were treated with intravenous injection of 50mg tramadol as a remedy when VAS was more than 4.VAS and RSS were followed up and recorded at 1h,6h,12h,24h and 48h postoperatively.Total number of PCIA presses and counts of remedial analgesia in the three groups were recorded within 48h.Blood samples were collected at preanesthesia,postoperative 24h and 72h,and using flow cytometry to detect changes of T lymphocyte subgroups(CD3~+,CD4~+,CD8~+,CD4~+/CD8~+)B cells(CD3~-CD19~+)and NK cells(CD3~-/CD16~+CD56~+),and the postoperative complications were followed up.Resullts:1 patient in group C need blood transfusion,and 1 patient’s pathology suggested benign,both of them were excluded.1 patient in group T refused to take blood samples after surgery,and another patient had to be examined by laparotomy repetitively after surgery,all of which were removed.1 patient in group N was excluded as blood transfusion,and 1 case was excluded because of the operation time was greater than 5h.A total of 114 patients were included in the statistical results.Compared with group C,VAS at 1h,6h,12h postoperatively were significantly decreased in group T and group N,total number of PCIA presses in group N were significantly decreased,the percentage of CD3~+,CD4~+at postoperative 24h and 72h and the percentage of NK at postoperative 72h in group N were significantly increased(P<0.05).Compared with group T,VAS at 1h,6h,12h 48h postoperatively and RSS at postoperative 1h were significantly decreased in group N(P<0.05),the percentage of CD3~+,CD4~+and CD4~+/CD8~+at postoperative 24h and the percentage of NK at postoperative 72h in group N were significantly increased(P<0.05).Compared with preanesthesia,percentage of CD3~+,CD4~+,CD4~+/CD8~+and NK were significantly reduced in the all three groups(P<0.05).Compared with 24h after surgery,percentage of NK cells at postoperative 72h were significantly increased in group N(P<0.05).2 patients in group N experienced nausea or vomiting but 9 in group C and 10 in group T,the incidence of nausea or vomiting in group N was statistically decreased(P<0.05).Conclusion:The Multimode Analgesia of nalbuphine combined with abdominal transverse plane block is satisfactory for the postoperative analgesia of liver cancer resection.The incidence of postoperative nausea or vomiting is significantly reduced and it has a protective effect on the immune function of surgical patients.