To Observe The Effect Of Magnesium Sulfate Combined With Ropivacaine For Abdominal Wall Nerve Block In Gynecological Laparoscopic Surgery

Objective: To investigate the analgesic effect and safety of magnesium sulfate combined with ropivacaine in abdominal wall nerve block(transversus abdominal plane block combined with rectus sheath block)for patients undergoing gynecological laparoscopic surgery.Methods: This study was a single-center retrospective matched case-control cohort study,which retrieved the clinical data of patients undergoing elective gynecological laparoscopic surgery(non-malignant tumor surgery)with Neusoft Electronic Medical Record Information Management System and Neusoft Surgical Anesthesia Information Management System in the Affiliated Hospital of Guilin Medical University from September 2019 to March 2021.Thirty-one patients who underwent abdominal wall nerve block with magnesium sulfate as ropivacaine hydrochloride adjuvant after induction of general anesthesia were collected.Two patients were excluded due to conversion to laparotomy.Finally,29 patients who were included in the ropivacaine hydrochloride+magnesium sulfate group(RM group)were collected for statistical analysis.In this study,29 patients who underwent abdominal wall nerve block in ropivacaine hydrochloride after general anesthesia induction with similar age,height,weight,BMI,education level,ASA classification,operation and anesthesia time,and total doses of remifentanil and propofol were randomly collected.They were included in the ropivacaine hydrochloride group(R group)and 29 patients who did not undergo nerve block after general anesthesia induction were included in the general anesthesia group(GA group).The mean arterial pressure and heart rate,static and dynamic VAS scores at 3h,6h,12 h,and 24 h after the insertion of the first puncture outfit,total analgesia satisfaction score at 24 h after operation,nausea,vomiting,and nerve block were compared among the three groups,5 min after the insertion of the first puncture outfit(T1),5 min before the insertion of the first puncture outfit(T2),and 5 min after the insertion of the last puncture outfit(T3).Results: The main indicators were static and dynamic VAS scores at 3h,6h,12 h and 24 h after operation.Secondary indicators were total analgesic satisfaction score at 24 h after operation,mean arterial pressure and heart rate at T1,T2 and T3,and perioperative complications.The static VAS scores at 3h after surgery in the GA,R and RM groups were:(3.73±0.96)vs(3.40±0.91)vs(1.40±0.83),respectively(P < 0.001).The static VAS scores 6h after surgery were(3.47±0.91)vs(3.47±0.99)vs(1.47±0.64),P < 0.001;The static VAS scores at 12 h after surgery were:(3.87±0.99)vs(3.20±0.86)vs(1.67±0.62),P < 0.001;The static VAS scores 24 h after surgery were:(3.20±1.15)vs(2.80±1.01)vs(1.07±0.70),P < 0.001;The dynamic VAS scores 3h after surgery were(4.47±0.91)vs(3.73±0.88)vs(2.07±0.88),P < 0.001;The dynamic VAS scores 6h after surgery were:(4.47±0.91)vs(4.13±1.12)vs(2.33±0.72),P < 0.001;The dynamic VAS scores at 12 h after surgery were(4.73±0.96)vs(4.13±0.91)vs(2.20±0.77),P < 0.001;The dynamic VAS scores 24 h after surgery were:(4.00±1.25)vs(3.60±1.06)vs(1.73±0.80),P < 0.001;The static and dynamic VAS scores of the RM group at 3h,6h,12 h and 24 h after operation were significantly lower than those of the GA group and the R group(P < 0.05).There was no significant difference in the static and dynamic VAS scores of the GA group and the R group at 3h,6h,12 h and 24 h after operation(P>0.05).total analgesia satisfaction score at 24 h after operation: GA group[2.00(2.00)]vs R group [2.00(1.00)]vs RM group [3.00(0.00)],P=0.004.The postoperative analgesic satisfaction scores of RM group were significantly higher than those of GA group and R group(P<0.05).There was no significant difference in analgesic satisfaction scores of GA group and R group(P>0.05).There was no significant difference in mean arterial pressure or heart rate among the three groups(P>0.05),nor was there a significant difference in the incidence of nausea and vomiting 24 h after operation among the three groups(P>0.05).There was no case of magnesium poisoning,local anesthetic poisoning,perforation of the peritoneum,severe abdominal wall injury,infection,hemorrhage and other nerve block-related complications in all of the three groups.Conclusions: Abdominal wall nerve block with magnesium sulfate added in ropivacaine hydrochloride was used for gynecological laparoscopic surgery.Compared with ropivacaine hydrochloride alone,the static and dynamic VAS scores were significantly decreased,the analgesic satisfaction was significantly improved,and the incidence of related complications was low,indicating that the postoperative analgesic effect was better with the adjuvant magnesium sulfate,and the analgesic satisfaction was higher,which was safe and feasible.