Analysis Of The Application Value Of Rectus Sheath Combined With Transverse Abdominis Plane Block In Laparoscopic Appendectomy In Children

Objective:To investigate the value of the rectus abdominis sheath combined with transversus abdominis plane block in pediatric laparoscopic appendectomy and to improve the effectiveness and safety of anesthesia practice.Methods:With the consent of the Ethics Committee of our hospital and family members,90 children who were to undergo laparoscopic appendectomy were selected.The patients were randomly divided into three groups: group A(general anesthesia),group B(TAPB),and group C(TAPB+RSB).There were 30 children in each group.All the children in the three groups were under general anesthesia with conventional laryngeal mask airway during the operation.Group A(general anesthesia)did not perform any operation after laryngeal mask anesthesia;Group B(TAPB compound general anesthesia)planned to use 0.25% ropivacaine0.6ml/kg for bilateral TAPB operation under ultrasound guidance after general anesthesia;Group C(TAPB+RSB compound general anesthesia)was planned to use 0.25%ropivacaine 0.6ml/kg for ultrasound-guided bilateral TAPB combined with RSB operation after general anesthesia;Connect PCIA analgesia pump after operation.The indexes of 2h(T0),6h(T1),12h(T2)and 24h(T3)after operation were recorded.(1)Observe and record the general information and operation time of the children;Record the dosage of narcotic analgesics used during operation;(2)The analgesic scores at different time points in each group were recorded by VAS score;(3)Ramsay sedation score was used to record the sedation score at different time points;(4)BCS comfort score was used to record the comfort scores at different time points;(5)Observe and record the time when patients in each group pressed PCIA for the first time,and record the times of pressing at each time point;Observe the PCIA complications of patients in each group.(6)Record whether there is any damage to the puncture site in group B(TAPB combined with general anesthesia)and group C(TAPB + RSB combined with general anesthesia),and whether there is any adverse reaction related to the puncture operation after operation.Results:(1)The general data of three groups of children showed that there was no statistical difference among the groups(P > 0.05).(2)VAS scores of three groups of children at different time points after operation:Group C(TAPB+RSB compound general anesthesia)had the best effect in early analgesia,and the pain was almost the same in 24 h.(3)Ramsay scores of three groups of children at different time points showed that C(TAPB+RSB compound general anesthesia)group had the best early sedation effect,and the degree of sedation at 24 h was basically similar..(4)BCS scores of three groups of children at different time points were compared.Patients in group C(TAPB+RSB compound general anesthesia)had the highest early comfort,and the 24-hour comfort was basically close.(5)Comparing the dosage of remifentanil used in three groups of children during operation,it shows that RSB combined with TAPB can reduce the dosage of remifentanil during operation.(6)Comparing the time and times of first pressing PCIA among the three groups,the first pressing time of C(TAPB+RSB compound general anesthesia)group is the latest,and the first pressing times of C(TABB+RSB)group are the lowest within 24 h.Compared with general anesthesia and general anesthesia plus TAPB,TAPB combined with RSB under general anesthesia has better analgesic effect and reduces the dosage of opioids after operation.(7)Compared the incidence of PCIA nausea and vomiting and other related complications among the three groups,the lower the dosage of narcotic analgesics after operation in group C(TAPB+RSB compound general anesthesia),the lower the corresponding complications.(8)No nerve block or operation-related complications occurred in the two groups of B(TAPB combined with general anesthesia)and C(TAPB+RSB combined with general anesthesia).Conclusions:The application of rectus abdominis sheath combined with transverse abdominis plane block combined with general anesthesia in children undergoing laparoscopic appendectomy can obtain good early analgesic effect,and at the same time,it can reduce the dosage of opioids and postoperative adverse reactions.It can be used as a clinical choice for effective analgesia after laparoscopic appendectomy in children,with fewer postoperative complications and safer,and it is worthy of further popularization and application.