The Effects Of Butorphanol Added To Ropivacaine In Transversus Abdominis Plane(TAP) Block For Postoperative Analgesia And Early Rehabilitation Following Gynecological Laparoscopy

Objective To evaluate the effects of butorphanol added to ropivacaine in transversus abdominis plane?TAP?block for postoperative analgesia and early rehabilitation following gynecological laparoscopy.Methods Sixty American Society of Anesthesiologists physical status?^?patients,aged 18⁶0 yr,weighting 50 kg and above,scheduled for elective gynecological laparoscopy under general anesthesia,were divided into two groups?n=30 each?using a random number table:TAP block with0.375%ropivacaine 20 ml and 0.9%saline 1 ml?group BR?or 0.375%ropivacaine 20 ml and 0.1%butorphanol 1 ml?group R?.All patients received bilateral TAP block after induction of general anesthesia.The HR and MAP at 5 min after admission to the operating room?T₀?,at 5 min before skin incision?T₁?,at 5 min after skin incision?T₂?,and at the end of pneumoperitoneum?T₃?were recorded.The intraoperative consumption of propofol and remifentanil,the VAS scores at 2 h and 24 h after operation,the recovery time of postoperative intestinal function and normal activity,QoR-40 in 24 h after operation,requirement for rescue analgesia,postoperative untoward reactions were recorded.At 5 minutes after admission to the operating room?T₀?and 2 h?T₄?and 24 h?T₅?after operation,venous blood samples were collected for measurement of the plasma concentration of IL-6 and IL-10.Results1 Comparison of hemodynamic changes at different time points in two groups:No significant change was found in MAP and HR at T₀,T₁ and T₃in two groups?P>0.05?.Compared with group R,MAP and HR were decreased at T₂ in group BR?P<0.05?.2 Comparison of the intraoperative consumption of propofol and remifentanil in two groups:No difference was found in the intraoperative consumption of propofol between group BR and group R?P>0.05?.Compared with group R,the intraoperative consumption of remifentanil was decreased in group BR?P<0.05?.3 Comparison of VAS scores in two groups at 2h and 24h after operation:Compared with group R,the VAS scores at 2h after operation were decreased in group BR?P<0.05?.No difference was found in the VAS scores at 24h after operation between group BR and group R?P>0.05?.4 Comparison of recovery time of intestinal function,ambulation and QoR-40 scores in two groups:Compared with group R,QoR-40 scores were increased in group BR?P<0.05?.There was no significant difference in recovery time of intestinal function and ambulation in two groups?P>0.05?.5 Comparison of requirement for rescue analgesia and postoperative untoward reactions:Compared with group R,the requirement for rescue analgesia was decreased in group BR?P<0.05?.There was no significant difference in postoperative nausea and vomiting in two groups?P>0.05?.No respiratory depression,pruritus and infection or hematoma at puncture site were observed in both two groups.6 Comparison of the plasma IL-6 and IL-10 concentrations at different time points in two groups:Compared with T₀,the plasma concentration of IL-6 and IL-10 at T₄ and T₅ were increased in two groups?P<0.05?.Compared with T₄,the plasma concentration of IL-6 and IL-10 at T₅ were increased in two groups?P<0.05?.Compared with group R,the plasma concentration of IL-6 was decreased and the plasma concentration of IL-10was increased in group BR?P<0.05?.Conclusions Combination of butorphanol and ropivacaine used in transversus abdominis plane block can stabilize perioperative hemodynamics,reduce the intraoperative consumption of remifentanil,relieve postoperative pain and improve quality of recovery after anesthesia.