Study Of Analgesic Effect Of Single Multimodal Analgesia After Laparoscopic Cholecystectomy

ObjectiveTo observed mainly the effectiveness and incidence of adverse reactions of a single multimodal analgesia regimen with Local infiltration of ropivacaine,Low-dose lornoxicam wound spraying and slow intravenous drip of dizocine Method(1)According to the enrollment criteria,200 patients were selected who underwent elective laparoscopic cholecystectomy at the Department of Hepatobiliary Surgery,Baoji People’s Hospital from March 2018 to July 2018.During the research experiment,24 patients withdrew according to outbound event criteria,and 176 patients completed finally clinical observations.According to the patients’ voluntary choice of postoperative analgesia,the patients were divided into three groups: Group F was the control group and a total of 37 completed clinical studies,and intermittent intramuscular injection of painkillers were used according to the patient’s pain request.Group D was the study group and a total of 55 patients were observed,and a single multi-mode analgesia technique was performed after surgery.Group P was the conventional treatment control group and 84 patients completed clinical studies,and a continuous intravenous analgesia using non-automatic device disposable analgesia pump was conducted after surgery.(2)Postoperative analgesia method:In group D,250 ml 0.9% sodium chloride injection plus 5mg dextrozine and 16 mg lornoxicam slowly intravenous drip at about 15 min before the end of surgery.At the end of the operation,10 ml 0.5% ropivacaine was used to local infiltration at puncture the hole(4ml for puncture under the xiphoid,3ml for each of the other two punctures).The liver wound was sprayed with 10 ml 0.125% ropivacaine.6mg Granisetron injection was administered into the pot at the end of the operation.For group P,continuous intravenous analgesia was performed at the end of the operation.Specific regimen: 100 ug sufentanil injection,6mg granisetron injection and 100 ml 0.9%sodium chloride injection were added to the non-automatic disposable analgesia pump for infusion at a constant rate of 2ml per hour.For group F,250 ml of 0.9% sodium chloride injection was used by slowly intravenous drip about 15 minutes before the end of surgery.At the end of the operation,10 ml of saline was used to locally infiltrate endoscopic puncture(4 ml for the xiphoid puncture hole,and 3 ml for the other two punctures).6mg granisetron injection was administered into the pot at the end of the operation.(3)Study index: Record included the general condition of the patient and the duration of intraoperative pneumoperitoneum,Intraoperative dosages of Propofol injection and Remifentanil hydrochloride for injection,as well as times of patients’ blinked time and extubation.VAS scores and comfort BCS scores of incision pain were recorded at 0 h(T0),4 h(T1),8 h(T2),12 h(T3),24 h(T4)and 48 h(T5)after PACU.When patient was in the PACU,if VAS score was greater than 3 for patients,Sufentanil was administered intravenously at 5 ug/s until the VAS score was less than 3 points,but,patient was in the ward,100 mg Tramadol was intramuscular injection if patients’ VAS score was greater than 3 points,and the number of patients who using Sufentanil in PACU or Tramadol in the ward were recorded.Relevant adverse reactions such as nausea,vomiting,drowsiness,dizziness and waist or shoulder pains were recorded.Changes in SBP,DBP and HR were recorded including the baseline value(T0,before induction),T1(after induction),T2(after intubation),T3(after extubation),and T4(after entering the PACU)were recorded,and the patient’s first time to get out of bed was recorded.The patients were asked to overall evaluate postoperative analgesia,then the patient’s satisfaction survey results were recorded which were classified as satisfactory,general,and dissatisfied with its cause.Result(1)There were no significant differences among group F,D,P patients in body weight,age,intraoperative pneumoperitoneum time,intraoperative propofol injection,intraoperative remifentanil dosage,extubation time and blink time(P>0.05).(2)There were no significant differences in SBP,DBP and HR among group F,D,P patients at different time points,which including the baseline value before induction(T0),after induction(T1),after intubation(T2),after extubation(T3),after PACU(T4)(P>0.05).(3)However,there were significant differences in VAS and BCS at T0,T1,T2,T3 and T4 among the three groups(P<0.01),but not only for T5(P>0.05).(4)There were a statistically difference in the satisfaction of patients among group D,group P and group F(P<0.01),with the highest satisfaction in group D(81.82%,45/55)and the lowest satisfaction in group F(43.24%,16/37).(5)The significant differences existed in the incidences of nausea and vomiting,drowsiness,waist or shoulder pains,usage rates of sufentanil in PACU and tramadol in ward among group D,group P and group F(P<0.01),and nausea and vomiting,drowsiness,waist or shoulder pains,usage rates of sufentanil in PACU and tramadol in ward were the lowest in group D.(6)Differences of the incidences of pruritus among group D,group P and group F was no significant(P>0.05).(7)for three groups,there were a statistically difference in the time of getting out of bed for the first time(P<0.01),of which group D was the earliest.ConclusionThis findings showed that a single multimodal analgesia technique not only has excellent analgesic effect,but also less adverse reactions after laparoscopic cholecystectomy.The single multimodal analgesia technique was safe and reliable with fewer side effects in appling to laparoscopic cholecystectomy for analgesia.The postoperative pain is significantly reduced,which enhanced the patient’s confidence in getting out of bed,and effectively shorten postoperative bed rest time,and prevented the occurrence of postoperative complications.At the same time,this technique also reduced the cumbersome postoperative analgesia pump and effectively reduced the medical expenses.In short,the technique was worthy of clinical promotion.