Effect Of Ultrasound-guided Transversus Abdominis Plane Block With Different Paths On Postoperative Analgesia After Upper Abdominal Surgery

Objective:Upper abdominal surgery techniques are widely used in hepatobiliary surgery and gastrointestinal surgery,among others.Although surgery is less traumatic than open surgery,many patients still complain of moderate to severe postoperative pain,and perfect postoperative analgesia is especially important.Traditional postoperative analgesia is mainly intravenous and epidural analgesia,but currently nerve block techniques are also widely used for anesthesia and postoperative analgesia.The transversus abdominis plane block can block the nerve conduction that innervates the abdominal incision,so that the pain in the abdominal wall can be relieved,and it is widely used for postoperative analgesia in abdominal surgery.However,studies on different routes of transversus abdominis plane（TAP）blocks are still limited.Clinical reports on the range of action and effect produced by various access routes are less reported,and there is no comparison on the site selection of access routes.In this paper,we focus on the effect of ultrasound-guided transversus abdominis plane blocks on postoperative analgesia in patients undergoing upper abdominal laparoscopic surgery,and evaluate the analgesic effect to provide value for TAP approach selection and better clinical service.Methods:A total of 90 patients undergoing elective upper abdominal surgery under general anesthesia with ASA classification I-III were selected and randomly divided into general anesthesia compounded with inferior transversus abdominis plane block at the upper costal margin（group A,30 patients）,general anesthesia compounded with inferior transversus abdominis plane block at the lower costal margin（group B,30 patients）and general anesthesia compounded with transversus abdominis plane block at the mid-axillary line（group C,30 patients）.Patients with severe cardiovascular and respiratory diseases,abnormal liver and kidney function,local anesthetic allergy,puncture site infection,and abnormal coagulation function were excluded.Peripheral venous access was routinely opened and routine heart rate,blood pressure（noninvasive）,and oxygen saturation monitoring was performed in the three groups of patients after admission.Bilateral TAP block was performed before general anesthesia,and the injected drug was 20 ml of 0.25%ropivacaine,40 ml in total bilaterally.30 min later,the TAP blocking plane was measured by the cold temperature method.After the induction of general anesthesia,midazolam 0.05mg/kg,sufentanil 0.4μg/kg,propofol2mg/kg and rocuronium 0.8mg/kg were injected intravenously,and the trachea was intubated 2min later,and the anesthesia machine was connected for mechanical ventilation.Intraoperatively,all intravenous anesthesia was maintained with continuous infusion of propofol 3-6mg/（kg*h）,dexmedetomidine 0.4μg/（kg*h）and remifentanil 0.2μg/（kg*h）,with additional inotropic drugs according to pharmacokinetics and intermittent administration of sufentanil.The electroencephalographic bifrequency index（BIS）was monitored during surgery,and the intraoperative anesthetic medication was adjusted to maintain the patient’s BIS value between 40 and 60.After surgery,an intravenous analgesic pump was administered with sufentanil 3μg/kg,flurbiprofen 100 mg and 0.9%sodium chloride injection to 100 ml,and the flow rate of the pump was modulated to 2 ml/h.After surgery,the patient was escorted to the resuscitation room for continued anesthetic monitoring.After the patient’s spontaneous breathing and consciousness were restored,the tracheal tube was removed and the patient’s vital signs were observed to be stable for 30 min and then sent back to the ward.Intraoperative sufentanil dosage,intraoperative MAP and HR at 6 time points（T₀,T₁,T₂,T₃,T₄、T₅）,operative time,postoperative analgesic dosage,postoperative quiet VAS score and cough VAS score at2h,4h,8h,12h,24h,postoperative extubation time and the occurrence of postoperative nausea and vomiting,agitation and other complications were recorded.Results:Compared with groups B and C,patients in group A had significantly lower intraoperative sufentanil dosage and postoperative flurbiprofen ester dosage（P<0.05）,significantly lower intraoperative mean arterial pressure values at all intraoperative points（P<0.05）and more stable hemodynamics,significantly lower VAS scores at 2h,4h,and 8h postoperatively at quiet and active times（P<0.05）,shorter postoperative extubation time（P<0.05）,and the incidence of hypotension,nausea and vomiting,and agitation was reduced（P<0.05）.Compared with group C,patients in group B showed no significant differences in sufentanil and flurbiprofen ester dosage,mean arterial pressure,postoperative nausea and vomiting,and agitation（P>0.05）,with smoother intraoperative heart rate（P<0.05）and lower VAS scores at 2h,4h,and 8h postoperatively during quiet and activity（P<0.05）.There was no significant difference in VAS scores at 24h postoperatively in the three groups at both quiet and active times.Conclusions:1.Ultrasound-guided inferior transversus abdominis plane block at the upper costal margin can reduce the amount of intraoperative anesthetics in patients undergoing upper abdominal surgery,resulting in smoother and less fluctuating intraoperative blood pressure.2.Ultrasound-guided inferior transversus abdominis plane block at the upper costal margin combined with intravenous analgesia in upper abdominal surgery can provide a better mode of postoperative analgesia,which can reduce the level of postoperative pain and decrease the incidence of postoperative nausea and vomiting and agitation.The use of transverse abdominal plane block in combination with intravenous analgesia for upper abdominal laparoscopy provides a better mode of postoperative analgesia.