Application Of General Anesthesia Combined With Different Nerve Block Methods In Renal Transplantation

Objective:To observe the effect of general anesthesia combined with quadratus lumborum block(QLB),general anesthesia combined with transverse plane block(TAPB)+rectus sheath block(RSB)and general anesthesia(GA)in renal transplantation,and to explore the most appropriate anesthesia mode for renal transplantation.Methods:A total of 90 patients who received elective allograft kidney transplantation in our hospital from September 2021 to May 2022 were selected and divided into three groups by random number table method(n=30): General anesthesia combined with quadrate lumborus block group(Q group),general anesthesia combined with transverse abdominis plane block + rectus sheath block group(TR group)and general anesthesia group(G group).In group Q,after general anesthesia induction,the anterior QLB of the operative side was injected with 0.33% ropivacaine 30 ml under ultrasound guidance.In TR group,TAPB and RSB were injected into the transverse abdominis plane and the posterior sheath of rectus abdominis by lateral approach under ultrasound guidance after general anesthesia induction.Group G received general anesthesia alone.The visual analogue scale(VAS)of the patients at rest and activity(cough or turning over)at 3h(T1),6h(T2),12h(T3),24h(T4),48h(T5)after surgery was recorded,and the dosage of sufentanil and remifentanil used during anesthesia was recorded.The intraoperative vital signs,the number of analgesic pump compressions within 24 hours and the time of the first compression of the analgesic pump were recorded,and the renal function and inflammatory indicators were recorded.The adverse reactions occurred within 48 hours after the operation were observed.Results:There were no significant differences in age,sex,ASA(american society of anesthesiologists)grading,body mass index(BMI),operation time and anesthesia time among3 groups(P>0.05).The dosage of sufentanil and remifentanil in Q and TR groups was lower than that in G group,and the difference was significant(P<0.05).The VAS score of Q group at rest at 3,6 and 12 h after surgery was lower than that of G group with significant difference(P<0.05),but there was no significant difference at rest at 24 and 48 h after surgery(P>0.05).The VAS score of TR group at rest was lower than that of G group at 3 and 6 hours after surgery and had a significant difference(P<0.05);the VAS score at rest 12 hours after surgery was lower than that of G group but had no significant difference(P<0.05);the VAS score at24 and 48 hours after surgery had no significant difference(P>0.05);The score of Q group was lower than that of TR group at all time points.There were statistical differences in the comparison of VAS at each time point of resting.VAS scores during activities(coughing or turning over): The VAS scores of Q group during activities 3 and 6 hours after surgery were lower than those of G group with significant differences(P<0.05),and the VAS scores of Q group during exercise 12 hours after surgery were lower than those of G group with significant differences(P<0.05).The VAS score of TR group was lower than that of G group at 3,6 and 12 hours after operation,and the difference was significant(P<0.05).There were no significant differences in VAS scores among all groups at 24 and 48 h after operation(P>0.05).The score of Q group was lower than that of TR group at all time points.There were statistical differences in VAS ratings at each time point of activity.Compared with group G,the number of analgesic pump compressions in groups Q and TR was lower and the first time of analgesic pump compressions was later(P<0.05).Intraoperative MAP and heart rate of the three groups showed no significant difference between the groups,while there were statistical differences within the groups.There was no significant difference in the incidence of postoperative adverse reactions among the three groups.The ratio of serum creatinine(SCr),urea nitrogen(BUN),cystatin C,hypersensitive C-reactive protein,procalcitonin,leukocyte,granulocyte and urine volume 1 day,3 day and 5 day after the operation of the three groups were analyzed and compared,and there was no statistical difference between the groups.There were significant differences in creatinine,cystatin C,urine volume,leukocyte,granulocyte ratio and procalcitonin.Conclusion: 1.General anesthesia combined with QLB or TAPB+RSB can enhance postoperative analgesia in renal transplantation patients,reduce the number of postoperative analgesia pump compressions and extend the first postoperative analgesia pump compressions,and the postoperative analgesia effect of general anesthesia combined with QLB is better than that of general anesthesia combined with TAPB+RSB;2.General anesthesia combined with QLB or TAPB+RSB can reduce the use of narcotic analgesics during kidney transplantation;3.General anesthesia combined with different nerve block methods has no difference in the incidence of adverse reactions and the recovery of renal function after renal transplantation.