Application Of Surface Anesthesia With Lidocaine And Ropivacaine Mixture In Postoperative Analgesia Of Patients Undergoing Vocal Cord Ambulatory Surgery

Objective Ambulatory surgery refers to a safe and reliable mode of surgery that the patients who meet a certain indication completes arranging the patient’s hospitalization,surgery,postoperative short-term observation,recovery（generally several hours）and discharge within one working day.In recent years,the mode of ambulatory surgery has developed rapidly in China and has been adopted and recognized by more and more medical institutions.Vocal cord lesions is a common benign disease in otorhinolaryngology,mainly polyps,nodules,cysts and so on in the vocal cord.Resection of vocal cord lesions by suspension laryngoscopy is a common treatment.This treatment has advantages that exposing the vocal cord well,facilitating the resection of vocal cord lesions,simple surgical steps,and being suitable for ambulatory surgery mode.But,intense stimulation that suspension laryngoscopy to laryngopharynx may lead to apparent hypertension and bradycardia easily.The operation time is relatively short,which requires enhanced recovery after surgery（ERAS）and achieving comfortable diagnosis and treatment.At present,there are few studies on which analgesic scheme is better for patients undergoing vocal cord surgery in the ambulatory surgery room.The purpose of this study is to investigate whether surface anesthesia with lidocaine and ropivacaine mixture can relieve early postoperative pain,improve the quality of anesthesia emergence and promote rapid recovery of patients undergoing vocal cord ambulatory surgery.Methods Ninety patients undergoing suspension laryngoscopy for benign vocal cord diseases in ambulatory surgery room of First Affiliated Hospital of Anhui Medical University,no gender limitation,aged 27～65（45.10±9.90）years,ASA gradedⅠ～Ⅱ,BMI 17.85～32.87 kg/m²,were enrolled in this study.The patients were assigned to three groups by computer-generated random number:sufentanil group（group S,n=30）,remifentanil group（group R,n=30）,and remifentanil+surface anesthesia group（group C,n=30）.The group S was induced by sufentanil,the group R by remifentanil,and the group C by remifentanil combined with surface anesthesia of surgical field.The three groups had the same anesthesia maintenance scheme.Mean arterial pressure（MAP）and heart rate（HR）of three groups were recorded at the time of entering the operating room（T₀）,before intubation（T₁）,immediately after intubation（T₂）,before positioning suspension laryngoscopy（T₃）,immediately after positioning suspension laryngoscopy（T₄）,before extubation（T₅）,immediately after extubation（T₆）.Spontaneous breathing recovery time,eye-opening time,command action time and time of extubation were recorded.The postoperative status of tube tolerance and immediate alertness/sedation scale（OAA/S）after extubation in PACU were recorded.Numeric rating scales（NRS）were recorded 40 min,6 h and 24h after the end of anesthesia.Post-operative quality recovery scale（PQRS）were recorded 1 day before the operation and 15 min,40 min,6h and 24h after the end of anesthesia.Results（1）General clinical data:There was no significant difference（P>0.05）among the three groups on gender,ASA classification,age,BMI,duration of anesthesia and education level;（2）Perioperative mean arterial pressure and heart rate:There was no significant difference（P>0.05）among the three groups on MAP and HR at each time point.（3）The status in PACU:Compared with group S,spontaneous breathing recovery time,eye-opening time,command action time and time of extubation in group R and group C were significantly shortened（P<0.05）.Compared with group R,the status of postoperative tube tolerance in group S and group C were significantly better（P<0.05）.There was no significant difference（P>0.05）on immediate alertness/sedation scores（OAA/S）after extubation among the three groups after extubation.（4）NRS score at different time points after the end of anesthesia:The analgesia of group S and group C were better than that of group R 40min after the end of anesthesia（P<0.05）.There was no significant difference（P>0.05）in postoperative analgesia among the three groups 6h and 24h after the end of anesthesia.（5）PQRS at different time points after the end of anesthesia:Compared with group S,the recovery of physiological function,emotion and cognitive function were better in group R and group C 15min after the end of anesthesia（P<0.05）.There was no significant difference（P>0.05）in the recovery of five aspects,physiological function,injurious reaction,emotion,daily activity ability,cognitive function,among the three groups 40min and 6h after the end of anesthesia.Compared with group S,group R and group C had better recovery in five aspects,physiological function,injurious reaction,emotion,daily activity ability,cognitive function,24h after the end of anesthesia,but there was no significant difference（P>0.05）.Conclusion For patients undergoing vocal cord surgery in ambulatory surgery room,surface anesthesia with lidocaine and ropivacaine mixture can relieve early postoperative pain,improve the quality of anesthesia emergence and enable patients to recover quickly.