Application Of Ultrasound-guided Rectus Sheath Block In Trans-umbilical Single Hole Laparoscopic Gynecological Surgery

Objective To observe the analgesic effect and clinical effect of ultrasound-guided rectus sheath block during and after single port laparoscopic gynecological surgery,provide new analgesic methods for such patients,and promote the development of perioperative multimodal analgesia and enhanced recovery after surgery(ERAS).Methods Sixty patients who underwent trans-umbilical single hole laparoscopic gynecological surgery in our hospital from February 2021 to January 2022 were enrolled.ThesepatientswereAmerican Association of Anesthesiologists(ASA)grade Ⅰ-Ⅱ,under 60 years old,average age(31.98±6.23)years,and the body mass index(BMI)less than 30 kg/m2,average(22.05±2.42)kg/m2.They were randomly divided into two groups(n=30):Ultrasound-guided rectus sheath block group(Group S)and local infiltration anesthesia group(group L).In group S,bilateral rectus abdominis sheath block was performed under ultrasound after anesthesia induction and intubation with 0.5%ropivacaine,15 ml on each side;In group L,gynecologists performed local infiltration anesthesia at the incision after anesthesia induction and intubation,with 30ml of 0.5%ropivacaine.All patients were given ketorolac tromethamine injection(30mg)intravenously after surgical resection of the lesion on the affected side,and providedmorphine intravenous patient-controlled analgesia(PCIA)after the operation.The visual analog scale(VAS)and Comfort Scale(BCS)were recorded at 2h,6h,12h,24h and 48h after operation.Intraoperative sufentanil dosage,the mean arterial pressure(MAP)and heart rate(HR)of the two groups before and after skin incision were recorded.Postoperative anal exhaust time,bed time and hospital stay werecompared.PCIA demands,PCIA morphine consumption,its adverse reactions and the number of patients with incomplete analgesia within 48 hours after operation was recorded.Results There was no significant difference in VAS scores between the two groups at 2 hours and 48 hours after operation(P＞0.05).But in group S,the VAS scores at 6 hours,12 hours and 24 hours after operation were lower than those in group L,with a significant difference(P<0.05).Compared with group L,group S had higher BCS scores at 6 hours,12 hours and 24 hours after operation indicating better patient comfort(P<0.05);There was no significant difference in sufentanildose during operation(P>0.05);There was no significant difference in the mean arterial pressure(MAP)and heart rate(HR)before and after skin resection between groups(P>0.05);The time to anal exhaust,getting out of bed and the days of hospitalization in group S were shorter than those in group L(P<0.05);The PCIA demands and the total PCIA morphine consumption in group S were significantly lower than that in group L(P<0.05);The incidence of adverse reactions and the number of patients with incomplete analgesia within 48 hours after operation in group S were less than that in group L(P<0.05).Conclusion Ultrasound-guided rectus sheath block in transumbilical single hole laparoscopic gynecological surgery provided definite analgesic effect during and after operation.Compared with local infiltration anesthesia,the analgesic effect of rectus sheath block lasts longer and the demand of postoperative opioids is reduced,which improves the comfort of patients,reduces the incidence of adverse reactions andenhance fast recovery of these patients.