Effect Of Opioid-free Anesthesia On Bowel Function In Patients With Laparoscopic Cholecystectomy

Objective:To explore whether opioid-free anesthesia can reduce the incidence of opioid-induced bowel dysfunction,we observed the use of opioid-free anesthesia in patients with elective laparoscopic cholecystectomy.So as to provide a reference for the drug selection of clinical anesthesia in laparoscopic cholecystectomy.Methods:During October 2019--October 2020,sixty patients(ASA I-II)were scheduled for laparoscopic cholecystectomy(LC)under inhalation combined with intravenous general anesthesia.The criteria of these patients are aged18-64,with BMI of 18.5-27.9kg/m~2,male and female unlimited.According to random number table method,the patients were divided into OFA group and OA group,with 30 patients in each group.After patients entering the operating room,venous access was opened,radial artery puncture and catheterization were performed under local anesthesia for invasive arterial pressure monitoring.During anesthesia induction,patients in both groups received propofol(Pro)1-2mg/kg,midazolam(Mid)0.05mg/kg,Cisatracurium(Cis-A)0.15mg/kg and sevoflurane 1.5-4%.In addition,patients in the OFA group were given ketorolac tromethamine(Ket)0.5mg/kg and lidocaine(Lid)1.5mg/kg.In the OA group,patients received sufentanil(SF)0.4ug/kg,and the same dose of normal saline with Lid in OFA group.During anesthesia maintenance,patients in both groups received Pro2-4mg/kg/hbycontinuousinfusionandsevoflurane1.5%-4%.Moreover,patients in OFA group received Lid 2mg/kg/h;while patients in OA group were given the same amount of normal saline and SF0.1ug/kg if necessary.The LMA was inserted after 3 minutes of anesthesia induction.Then,patient’s lungs were mechanically ventilated with an oxygen–air mixture.The mechanical ventilation parameters were set as follows:respiratory rate 12-16 times/min,tidal volume(VT)6-8ml/kg,to keep end-tidal carbon dioxide pressure at 35-45mm Hg.Patients in both groups were given 5ml lidocaine(1%)for infiltration anesthesia at the incision before operation.During the operation,patients’mean arterial pressure(MAP),heart rate(HR)and other vital signs were closely monitored,to keep Io C1 and Io C2 at 30-45.Vasoactive drugs such as ephedrine and atropine could be gived when necessary.In both group,sevoflurane was stopped after the gallbladder was removed and 10ml ropivacaine(0.5%)was used for incision infiltration anesthesia before abdominal closure.The intravenous anesthetic was stopped at the end of the operation.During the operation,MAP,HR,Io C1,Io C2,the time from drug withdrawal until the patients were fully awake to remove the LMA,bowel sound recovery time(t1),the first anus exhaustion time(t2)and first defecation time(t3),Visual analogue scoring(VAS)and postoperative adverse reactions such as nausea,vomiting,abdominal distension and difficulty urinating were recorded in two groups.Results:1 There was no statistical significant difference between the two groups in general data such as gender,age,BMI,ASA grade,the time of operation(t4)and the time of anesthesia(t5)(P>0.05).2 Compared with OA group,MAP and HR were higher at T1(when LMA was inserted)in OFA group,with statistical significance(P<0.05).But there were no statistical significant differences in MAP and HR between the two groups at other moments(P>0.05).3 Compared with group OA,the time from drug withdrawal until the patients were fully awake to remove the LMA is longer in OFA group with statistical significance(P<0.05).4 There was no statistical significance in postoperative VAS between the two groups(P>0.05).5 Compared with group OA,t1,t2 and t3 were shorter and the differences were statistically significant(P<0.05).6 The incidence of nausea,vomiting and abdominal discomfort in group OFA was less than those in group OA,and the differences were statistically significant(P<0.05).Conclusion:For patients undergoing elective laparoscopic cholecystectomy,opioid-free anesthesia is safe and feasible,and can reduce the incidence of opioid induced bowel dysfunction.Thus it can provide a reference for the selection of drugs for clinical anesthesia in laparoscopic cholecystectomy.