| Background and purposeThe pain mechanism of robotic-assisted laparoscopic surgery is complex,mainly including somatic pain caused by surgical incision,inflammatory pain caused by nociceptive stimuli,visceral pain and referred pain caused by chemical stimulation and mechanical traction.More than 80%of surgical patients will experience acute postoperative pain,which usually begins immediately after anesthesia disappears,causing stress and inflammatory reaction and inhibiting immune response.If the early postoperative pain is not controlled timely and effectively,the probability of progression to persistent postoperative pain is 30%-50%,which will affect the longterm prognosis.Local anesthetic diffusion during paravertebral block often blocks the sensory,motor and sympathetic nerve conduction on the homolateral side,and the analgesic effect is comparable to that of epidural block,which can effectively avoid the effect on the sympathetic nerve on the unaffected side,stabilize blood pressure,and decrease the adverse reactions of epidural block.It is a good anesthesia and analgesia method.There are few reports about the application of paravertebral block in roboticassisted nephrectomy.For the reason,this study compared the application effect of robot-assisted nephrectomy under general anesthesia combined with paravertebral block under ultrasonic guidance with that under general anesthesia alone to explore its influence on postoperative pain,inflammatory response and recovery quality of patients.MethodsA total of 100 patients with robot-assisted laparoscopic nephrectomy under elective general anesthesia,aged 18-70 years,with ASA Ⅰ-Ⅱ,were randomly divided into two groups:observation group(n=50,general anesthesia combined with paravertebral block under ultrasonic guidance group),and control group(n=50,general anesthesia group).Venous blood was collected from the two groups of patients at 1 day before surgery and 1,2 and 5 days after surgery to detect Interleukin 6(IL-6)and systemic immune inflammation index(SII).The 40-item quality of recovery(QoR-40)scale scores of patients in the two groups were recorded at 1 day before operation and 1,2 and 5 days after surgery.The VAS scores of patients at rest and cough were collected at 1,2 and 5 days after operation.Mean arterial pressure(MAP)and heart rate(HR)of patients were recorded at 10 min before anesthesia(T0),5 min before skin incision(T1),5 min after skin incision(T2),5 min after pneumoperitoneum(T3),at time of specimen collection(T4),at the end of operation(T5)and at the time of leaving the room(T6).The dosage of remifentanil,the times of effective pressing of analgesic pump,the times of remedial analgesia,the time of getting out of bed for the first time,anal exhaust time,the postoperative duration of hospitalization,the incidence of chronic pain and relevant adverse effects were collected.ResultsCompared with the control group,the observation group had lower MAP and HR at T2,T3,T4,T5 and T6(P<0.05).Compared with the control group,the VAS score at rest and cough,SII and IL-6 in the observation group were lower at 1,2 and 5 days after surgery(P<0.05).Compared with the control group,the scores of each item and total scores in the QoR-40 scale of the observation group were higher at 1 day after surgery(P<0.05).Compared with the control group,the comfort,emotional state,behavioral independence,pain sensation score and total scores in the QoR-40 scale of the observation group were higher at 2 days after surgery(P<0.05).Compared with the control group,the comfort,behavioral independence,pain sensation score and total scores in the QoR-40 scale of the observation group were higher at 5 days after surgery(P<0.05).Compared with the control group,the first time to get out of bed was earlier,the anal exhaust time was earlier,the postoperative hospitalization time was shorter and the incidence of chronic pain was lower in the observation group(P<0.05).The observation group had less intraoperative remifentanil dose,fewer effective pump compressions and remedial analgesia than that in the control group(P<0.05).The incidence of nausea and emesis in the observation group was lower after surgery than that in the control group(P<0.05).ConclusionGeneral anesthesia combined with paravertebral block under ultrasonic guidance can offer better perioperative analgesia effect for robot-assisted nephrectomy patients,and reduce the effects of surgical stimulation on hemodynamics.It can also reduce the dosage of opioids,relieve postoperative inflammatory reaction,decrease the incidence of postoperative chronic pain,and promote postoperative rehabilitation of patients. |
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