Study On The Effect Of Multi-mode Analgesia With Less Opioid Program In Retrolaparoscopic Renal Tumor Resection

Objective: To investigate the efficacy of Less Opioid Regimen Multi-modal Analgesia in Retrolap aroscopic Renal Tumor Resection.Methods: 60 cases of retroperitoneal laparoscopic renal tumor resection under elective general anesthesia were selected.Patients were randomly divided into low-opioid regimen multi-mode analgesia group(LO group)and standa rd anesthesia group(S group),with 30 cases in each group.(1)LO group: 10 minutes before surgery and at the time of closing the abdominal suture,50mg(a total of 100mg)flurbiprofen extranate was injected intravenously.After anesthesia induction intubatio n,the patients were placed in lateral position(affected side up),and 30 ml 0.5% ropivacaine was injected into the transverse process of T9 of erector spinae muscle on the affected side under ultrasound guidance.(2)S group: general anesthesia group.Anesthes ia induction、maintenance and resuscitation were performed by a uniform method in all patients.After the operation,patients in both groups were connected to self-controlled intravenous analgesia pump,but the analgesia drugs in the pump were different.The LO group was given flurbiprofen ester for analgesia,and the S group was given sufentanil for analgesia.After the operation,the VAS score of all patients was controlled to be less than 4 points.When the VAS score was greater than 4 points,Sufentanil wa s injected intravenously 0.1ug/kg/time for remedial analgesia.Record the time from the beginning to the end of the operation(hereinafter referred to as the operation time);VAS scores and BCS scores were recorded in T1(awake),T2(1 hour after surgery),T3(6 hours after surgery),T4(12 hours after surgery),T5(24 hours after surgery)and T6(48 hours after surgery)at each time point.The heart rate and mean arterial pressure of patients in Ta(before anesthesia administration),Tb(during skin resectio n),Tc(during carbon dioxide filling pneumoperitoneum)and Td(during lesion resection)at different periods of operation were recorded.The intraoperative consumption of sufentanil and remifentanil,the number of sufentanil relief analgesia within 48 hour s after surgery,and the number of effective pressure of analgesia pump within 48 hours after surgery were recorded between the two groups.The frequency of nausea and vomiting and the occurrence of adverse reactions such as respiratory depression were reco rded in both groups after the operation.The time from the end of the operation to the patient’s first exhaust(hereinafter referred to as the first exhaust time)and the time from the end of the operation to the patient’s first getting out of bed(hereinaf ter referred to as the first getting out of bed time)were recorded.Results: There were no significant differences in age,height,weight and operation time between the two groups(P > 0.05).There were no significant differences in VAS scores and BCS scor es at T1 and T6 between the two groups(P >0.05).VAS scores at T2,T3,T4 and T5 in LO group were lower than those in S group(P < 0.05).The BCS scores of T2,T3,T4 and T5 in LO group were higher than those in S group(P < 0.05).There were no significan t differences in heart rate and mean arterial pressure at Ta between the two groups(P > 0.05),and the heart rate and mean arterial pressure at Tb,Tc and Td in the LO group were lower than those in the S group.The intraoperative dosage of remifentanil in LO group was significantly less than that in S group(P < 0.05),and the intraoperative dosage of sufentanil was not significantly different between the two groups(P > 0.05).The first time of postoperative analgesic pump was later in LO group than in S g roup(P < 0.05).The number of effective analgesic pump compression in LO group was less than that in S group within 48 hours after surgery(P < 0.05).The number of postoperative sufentanil analgesia in LO group was less than that in S group(P < 0.05).The first exhaust time,first water intake time and first getting out of bed time in LO group were earlier than those in S group(P < 0.05).Postoperative adverse reactions such as nausea and vomiting were significantly less in LO group than in S group(P < 0.0 5).Conclusions: Compared with the analgesia after general anesthesia,ultrasound-guided eriospinal muscle plane block combined with flurbiprofen axetil in multi-mode analgesia with less opioid regimen is used for retrolaparoscopic renal tumor resection.It is helpful to reduce intraoperative and postoperative opioid consumption,provide patients with more effective analgesic effect,reduce intraoperative stress response,make circulation more stable,reduce the occurrence of postoperative adverse reactions,help patients get out of bed to eat in advance,and promote patients’ recovery.