Comparison Of Ultrasound-guided Rhomboid Intercostal And Subserratus Plane Block And Rectus Sheath Block In Laparoscopic Gastric Surgery

Objective:To compare the efficacy of ultrasound-guided rhomboid intercostal and subserratus plane（RISS）block and rectus sheath block（RSB）in laparoscopic gastric surgery.Methods:A total of 60 patients who were going to undergo laparoscopic gastric surgery were selected and given general anesthesia.The random number table method was used to divide them into three groups.Group A was general anesthesia combined with RISS block（n=20 cases）,Group B was general anesthesia combined with RSB（n=20cases）and group C was general anesthesia alone（n=20 cases）.Group A underwent ultrasound-guided RISS block before anesthesia.Group A was given four-point injection,and 15ml of 0.3%ropivacaine was administered to the left and right sides at the level of T6～T7 at 1～2cm of the medial border of the scapula.Meanwhile,15ml of ropivacaine with a concentration of 0.3%was given to the left and right sides of the T7～T8 level at the medial border of the scapula at 1～2cm.The total local anesthetic volume of group A was 60ml.Group B was given ultrasound-guided RSB before anesthesia.Group B also used four-point injection.15ml of ropivacaine with a concentration of 0.3%was administered to the left and right sides of the lateral border of the rectus abdominis at the supraumbilical level.15ml of ropivacaine with a concentration of 0.3%was given to the left and right sides of the border below the umbilicus.The total volume of local anesthesia in group B was 60ml,and group C was simply given general anesthesia.All the patients underwent anesthesia induction after ultrasound-guided nerve block,and patient controlled intravenous analgesia（PCIA）was used to relieve the pain caused by the operation.The intraoperative sufentanil consumption and the fluctuation of vital signs（mainly MAP and HR）5minutes before and 5 minutes after skin incision were recorded in each group;VAS at each time point after operation was recorded in each group.The scores were followed up and recorded,and the recording time was 0h,2h,4h,8h,12h,24h and 48h after the operation;The time when each group left the bed for the first time after the operation was recorded;The first transanal exhaust time of each group after the operation was recorded.Patients in each group who required additional rescue analgesia were recorded,mainly the number of patients in each group who required additional analgesia within 48 hours after surgery;The effective times of analgesic pump pressing and the occurrence of adverse reactions such as postoperative nausea and vomiting were recorded.Results:The MAP and HR at 5 minutes after skin incision and the difference in MAP and HR at 5 minutes before and after skin incision in group C were higher than those in group A and group B,and there was a significant difference（P<0.05）.Indicating that group A and group B,the changes in MAP and HR 5 minutes after skin incision were smaller in group patients,which was helpful to maintain the stability of intraoperative vital signs（mainly MAP and HR）and avoid large fluctuations in hemodynamics.The intraoperative consumption of sufentanil in group A and group B was significantly lower than that in group C（P<0.05）.There were significant statistical differences at24h（P<0.05）,but no significant differences at 0h and 48h after operation（P<0.05）.The results of pairwise comparison showed that the VAS of group C at each time after operation were significantly different（P<0.05）.At 2h,4h,8h and 12h,it was significantly higher than that of group A and group B（P<0.05）,and the VAS at 24h after operation showed that group B and group C were significantly higher than group A（P<0.05）.The results of pairwise comparison of the number of rescue analgesics in each group within 48 hours after operation showed that within 48 hours after operation,the proportion of the number of people who required additional rescue analgesics in group C was significantly higher than that in groups A and B（P<0.05）;After comparing the effective analgesic pump pressing times in each group,it was found that group C was significantly higher than groups A and B,and group B was significantly higher than group A,with significant statistical differences（P<0.05）.In the comparison of the proportion of cases of nausea and vomiting in each group,the proportion of cases of nausea and vomiting in group C was higher than that in group A and group B,with significant statistical difference（P<0.05）;After comparing the time of the patients in each group leaving the bed for the first time to go to the ground after the operation,it was found that the time of the first going to the ground in groups A and B was shorter than that in group C（P<0.05）;After comparing the time of first transanal exhaust after operation,it was found that the time of first transanal exhaust after operation in group A and group B was shorter than that in group C（P<0.05）.Conclusion:The intraoperative and postoperative effects of ultrasound-guided RISS block and RSB in laparoscopic gastric surgery were better than those of the simple general anesthesia group,which reduced the hemodynamic changes caused by surgery and CO₂pneumoperitoneum stimulation,which was conducive to maintaining the more stable vital signs of patients during surgery can effectively relieve the pain of abdominal surgery patients,save the dosage of sufentanil,reduce the need for rescue analgesics,and reduce the frequency of pressing the analgesic pump for pain relief.For laparoscopic gastric surgery,the dose of opioids is saved,which is beneficial to reduce the side effects caused by them,and the incidence of adverse reactions of opioids such as nausea and vomiting,respiratory depression,etc.will also be reduced.For patients with upper abdominal surgery,reduced pain sensitivity can promote transthoracic and transabdominal breathing,and they can be more willing to move down early,which will be more conducive to the patient’s rapid postoperative recovery（Enhanced recovery after surgery,ERAS）.In terms of postoperative analgesia,the analgesic effect of the ultrasound-guided RISS block group was comparable to that of the RSB group,but the analgesia time of the RISS block group was longer and the number of effective analgesic pump compressions was less.