Application Of Intranasal Butorphanol Combined With TAPB And RSB In Laparoscopic Cholecystectomy

Objective:To observe the effect of multimodal analgesia with butorphanol nasal drops combined with transversus abdominis plane block and rectus abdominis sheath block in daytime laparoscopic cholecystectomy.Methods:Eighty patients undergoing daytime laparoscopic cholecystectomy in our hospital from January 2022 to December 2022 were selected.All patients underwent traditional three-port laparoscopic surgery under general anesthesia by experienced hepatobiliary surgeons.Eighty patients scheduled for LC were randomly divided into four groups（n=80 each）.In group A,Butorphanol 0.02mg/kg was administered by nasal drip combined with 0.25%ropivacaine 60ml was used for ultrasound-guided right subcostal TAPB+bilateral RSB.In group B,the same dose of normal saline combined with 0.25%ropivacaine 60ml was used for right subcostal TAPB+bilateral RSB.In group C,Butorphanol 0.02mg/kg was administered by nasal drip combined with normal saline 60ml was performed with right subcostal TAPB+bilateral RSB.Group D;The control group received general anesthesia.Anesthesia was induced with midazolam 0.04 mg/kg,sufentanil 0.3μg/kg,target-controlled infusion of propofol3.5μg/ml,and rocuronium 1 mg/kg.Mechanical ventilation was performed immediately after tracheal intubation.Anesthesia was maintained with target-controlled infusion of propofol（3-4μg/ml）and remifentanil（4-6 ng/ml）.Narcotrend anesthesia depth was maintained around 45,and intraoperative PETCO₂was maintained between 35 and 45 mm Hg.Observation indicators:1.The mean arterial pressure（MAP）and heart rate（HR）of the four groups after entering the operating room,intubation,skin incision and pneumoperitoneum（T₁-T₄）;visual analogue scale pain scores at rest and during exercise at 2h,4h,6h and 12h after surgery（T₅-T₈）;3.Intraoperative consumption of remifentanil and additional cases of flurbiprofen axetil as rescue analgesic;5.Operation time,anesthesia recovery time（time from drug withdrawal to call for eye opening）,extubation time（time from drug withdrawal to extubation）;6.Incidence of postoperative complications such as nausea,vomiting,pruritus,urinary retention and respiratory depression;7.Ramsay sedation scores during intranasal butorphanol administration and 15min after completion of butorphanol administration.If the postoperative VAS score was more than 4 points,flurbiprofen axetil 50mg was intravenously injected as rescue measure.After 10minutes,the need for another dose was evaluated.If necessary,an additional 25mg/time until the VAS score was less than 4 points.Results:1.There was no significant difference in gender composition,age,BMI,basic diseases,ASA classification,operation time,recovery time and extubation time among the four groups（P>0.05）.2.Comparison of MAP and HR in the four groups at the four time points（T₁-T₄）:there was no significant difference in MAP and HR among the four groups at T₁（P>0.05）;The MAP and HR of group A and group C were lower than those of group B and group D at T₂（P<0.05）.At T₃and T₄,MAP and HR in group A were lower than those in group B,group C,and group D,while those in group D were higher than those in group B and group C（P<0.05）.There was no significant difference between group B and group C（P>0.05）.3.Comparison of VAS scores at rest and during exercise among the four groups at each time:At T₅,T₆and T₇,the VAS scores at rest and exercise in group A were lower than those in group B,group C and group D,while the VAS scores at rest and exercise in group B and group C were lower than those in group D（P<0.05）.There was no significant difference between group B and group C（P>0.05）.At T₈,the VAS scores at rest and during movement in group A were significantly lower than those in group B,group C and group D（P<0.05）,while there was no significant difference among group B,C and D（P>0.05）.4.The dosage of remifentanil in group A was less than that in group B,group C and group D,while the dosage of remifentanil in group D was more than that in group B and group C（P<0.05）.There was no significant difference between group B and group C（P>0.05）.The frequency of flurbiprofen axetil rescue analgesia in group D was significantly higher than that in group A,group B and group C（P<0.05）,but there was no significant difference between group A,group B and group C（P>0.05）.5.There was no respiratory depression in the four groups after operation,and there was no difference in the incidence of pruritus and urinary retention（P>0.05）.The incidence of nausea and vomiting in group A and group C was lower than that in group B and group D,and the difference was statistically significant（P<0.05）.6.Comparison of Ramsay sedation scores between the four groups when intranasal butorphanol was given and 15min after intranasal butorphanol was given:there was no statistically significant difference in Ramsay sedation scores between the four groups when intranasal butorphanol was given（P>0.05）.The Ramsay scores of group A and group C were lower than those of group B and group D 15 minutes after nasal drip（P<0.05）.Conclusion:Ultrasound-guided transversus abdominis plane block plus rectus abdominis sheath block and nasal butorphanol can both effectively reduce the pain within 6hours after laparoscopic cholecystectomy,reduce the use of intraoperative opioids and The Times of postoperative rescue analgesia.The combination of the two multimodal analgesia has better effect,lower postoperative pain score,and analgesia time can reach 12 hours.