| Objectives To observe the effect of bilateral subcostal transversus abdominis plane(TAP)combined with rectus sheath(RS)block on early recovery of laparoscopic sleeve gastrectomy(LSG).Methods A randomized controlled trial design was used to collect 60 LSG patients admitted to Tangshan Workers’ Hospital from October 2020 to January 2022 according to the grading criteria.According to the random number table method,the study subjects were divided into two groups: experimental group(TR group)that underwent bilateral ultrasound-guided TAP combined with RS block before surgery and control group(G group)that did not undergo nerve block before surgery,with 30 cases in each group.In the TR group,ultrasound-guided TAP combined with RS block was performed by anesthesiologists in the first group before surgery.G group received general anesthesia without nerve block.Those who performed intraoperative anesthesia management and data collection(the second group and the third group)did not participate in the nerve block procedure.Hemodynamic changes(blood pressure and heart rate)of patients were collected at different time points during surgery: T0(before anesthesia),T1(10 min after induction of general anesthesia),T2(30 min after establishment of pneumoperitoneum),T3(immediately after operation),T4(4 h after surgery),T5(8 h after surgery),and T6(12h after surgery).The incidence of intraoperative adverse events(hypertension,hypotension,sinus tachycardia,sinus bradycardia);Intraoperative dosage of anesthetic propofol injection and remifentanil hydrochloride;Early postoperative anesthesia recovery(the time from drug withdrawal to recovery of spontaneous breathing,eyes opening and extubation);Analgesic remedy drug use within 48 h after surgery(the first 24 h,the second 24 h):dosage of flurbiprofen ester,number of flurbiprofen ester users,dosage of ketorolac ambutriol,number of ketorolac ambutriol users;Postoperative adverse reactions(such as nausea,vomiting,hypoxemia,etc.)occurred.The time from the end of surgery to the first time out of bed,the length of postoperative hospitalization and the total hospitalization cost.SPSS 25.0 software was used for data processing,and P<0.05 was considered statistically significant.Results 1 Comparison of general basic information: among the patients who were eventually included in the study,24 were male patients,accounting for 40.0%,36 were female,accounting for 60.0%.Age between the two groups,American Society of Anesthesiologists(ASA)rating,sex,height,total body weight(TBW),body mass index(BMI),lean body weight(LBW)and operation time had no significant differences(P>0.05).2 Comparison of intraoperative dosage of anesthetic propofol injection and remifentanil hydrochloride: there was no significant difference in the dosage of propofol injection between the two groups(P>0.05);Compared with G group,the dosage of remifentanil hydrochloride in TR group was reduced,and the difference was statistically significant(P<0.05).3 Early postoperative anesthesia recovery: compared with G group,the withdrawal time of drug to spontaneous breathing,withdrawal time of drug to eye opening and withdrawal time of drug to extubation were shortened in TR group,with statistically significant differences(P<0.05).4 Compared with T0,the mean arterial pressure(MAP)and heart rate(HR)of G group at T4 point were higher than those at T0 point,the differences being statistically significant(P<0.05).There was no significant difference between other time points and T0 time point(P>0.05).There was no significant difference between TR and T0 time points(P>0.05).Compared with G group,at T4 time point,MAP and HR in TR group were lower than G group,the differences were statistically significant(P<0.05).There was no significant difference between the two groups at other time points(P>0.05).There were no significant differences in the incidence of hypertension,hypotension,sinus tachycardia and sinus bradycardia between the two groups(P>0.05).5 Use of postoperative analgesic remedies: compared with G group,the dosage of flurbiprofen ester and ketorolac ambutriol in TR group was reduced in the first24 hours after surgery,with statistical significance(P<0.05).6 Comparing the incidence of postoperative nausea,vomiting,hypoxemia and other adverse reactions between the two groups: compared with G group,the incidence of nausea and vomiting in TR group was reduced,and the difference between the two groups was statistically significant(P<0.05).No hypoxemia occurred in both groups.7 Comparison of early postoperative recovery between the two groups: there was no significant difference between the two groups in terms of activity time from postoperative to the first time out of bed,length of postoperative hospitalization and total hospitalization cost(P>0.05).Conclusions For patients with LSG,ultrasound-guided bilateral subcostal TAP combined with RS block can reduce the dosage of analgesics used during and 24 h after surgery,which is beneficial to early recovery of patients to a certain extent.Figure 5;Table 9;Reference 129... |
PDF Full Text Request