Influence Of Ultrasound-guided Transversus Abdominis Plane Block On The Analgesic Effect During And After Laparoscopic Partial Nephrectomy

Objective: To observe the effect of ultrasound-guided transversus abdominis plane block(TAPB)on intraoperative and postoperative analgesia of laparoscopic partial nephrectomy(LPN).Methods:Sixty patients who underwent laparoscopic partial nephrectomy from November 2019 to January 2021 in Shengjing Hospital Affiliated to China Medical University.They were randomly divided into the local block group(group C)and the TAPB group(group T),with 30 cases in each group.In group T,nerve block was performed by a same anesthesiologist under ultrasound guidance after induction of general anesthesia.Choose the two-point combination of the subcostal approach and the lateral approach on the affected side,and inject 20 ml of 0.375% ropivacaine solution at each point.Patients in group C underwent local block.The anesthesia maintenance of the two groups of patients was combined with intravenous inhalation.We selected nitrous oxide and sevoflurane as the inhaled gas.On the basis of maintaining the MAC between1.0 and 1.2,we adjust the pump dose of remifentanil according to changes in blood pressure and heart rate during the operation to maintain blood pressure within 20% of its basic value.After surgery,both groups of patients used sufentanil intravenous controlled analgesia as remedial analgesia.After the two groups were given a loading dose,the patients in both groups started intravenous self-controlled analgesia.Observation indicators: 1.Observe the blood pressure and heart rate before the operation,3 minutes after the skin incision,3 minutes after the tracheal intubation is removed,and the dosage of remifentanil and muscle relaxants during the operation.2.Observe and record the VAS score and Ramsay score during rest and activity at 1,2,4,6,12,24 hours after operation,the number of PCIA compressions within 24 hours after operation,and the occurrence of adverse reactions.Results:(1)Intraoperative skin incision and extubation stimulation response of T group was significantly lower than that of C group,and blood pressure and heart rate did not change significantly.The total cumulative dosage of remifentanil during the operation was less than that of group C.There were differences Statistically significant(P <0.05).Although the dosage of muscle relaxant was less than that of group C,there was no statistical difference;(2)Postoperative analgesia score: The VAS score of rest and activity at 1h,2h,4h,6h,12 h after operation in group T was lower than that of group C.The difference was significant(P <0.05);there was no statistically significant difference in the VAS scores of the two groups at 24 h after the operation,and the Ramsay scores at1 h,2h,4h,6h,12 h,and 24 h after the operation were not statistically significant.(3)The cumulative number of analgesic pump compressions in the T group(7.87±2.97)was less than that of the C group(9.57±3.36)within 24 hours after the operation.The difference was statistically significant P <0.05);(5)Postoperative nausea,The probability of vomiting was 10%(3/30),and the probability of group C was 13%(4/30).There was no statistical difference between the two groups.No other complications occurred.Conclusion:Ultrasound-guided TAPB can not only reduce the early postoperative pain of patients undergoing laparoscopic partial nephrectomy,but also reduce the amount of intraoperative and postoperative opioid analgesics,and maintain vital signs more stable.It is a good anesthesia options for patients undergoing laparoscopic partial nephrectomy.