Effects Of Different Anesthesia And Analgesia On Postoperative Insulin Resistance In Patients With Gastric Cancer

Objective: To investigate the effects of different anesthesia and analgesia methods on analgesia,inflammatory response and postoperative insulin resistance in patients undergoing laparoscopic radical gastrectomy.Methods: Sixty patients undergoing laparoscopic radical gastrectomy in Rizhao People ’s Hospital from January 2018 to September 2020 were selected.They were randomly divided into two groups,general anesthesia group(group C)and epidural combined with general anesthesia group(group E),30 cases in each group.Patients in group C received general anesthesia with tracheal intubation,postoperative patient-controlled intravenous analgesia(PCIA),sufentanil 150 ug + ondansetron 16 mg,patients in group E received general anesthesia with tracheal intubation after epidural(T8-9)puncture and catheterization,postoperative patient-controlled epidural analgesia(PCEA),ropivacaine 75 mg.Peripheral venous blood was collected from the two groups of patients at 5 min after admission(T0),12 h after surgery(T2),24 h after surgery(T3),and 48 h after surgery(T4).The blood glucose concentration and insulin concentration were measured by a fully automated analyzer,and the insulin resistance index(IRI)was calculated.The level of C-reactive protein(CRP)was detected by enzyme-linked immunosorbent assay(ELISA).The resting and cough visual analogue scale(VAS)of the two groups were evaluated at 6h(T1),12h(T2),24h(T3)and48h(T4)after operation.The preoperative general conditions of the two groups were recorded,including gender,age,body mass index(BMI)and ASA classification.The intraoperative blood loss,remifentanil dosage and operation time were recorded in the two groups.The first exhaust time,first ambulation time,hospitalization days,adverse reactions within 48 hours and analgesia satisfaction were recorded in the two groups.Results:(1)There was no significant difference in gender,age,body mass index(BMI)and ASA classification between the two groups(P>0.05).There was no significant difference in intraoperative blood loss and operation time between the two groups(P>0.05).Compared with group C,the dosage of remifentanil in group E was decreased(P<0.05).Compared with group C,the recovery time of spontaneous breathing and extubation time decreased in group E(P<0.05).(2)At the four time points of T1,T2,T3 and T4,compared with group C,the resting and coughing VAS of group E decreased(P<0.05).(3)At T2,T3 and T4,compared with group C,the level of CRP in group E was lower(P<0.05).(4)At T2,T3 and T4,compared with group C,the concentrations of blood glucose and insulin,the postoperative IRI of group E were significantly lower(P<0.05).(5)Compared with group C,the first exhaust time,the first ambulation time and the length of hospital stay in group E were decreased(P<0.05),and the postoperative analgesia satisfaction in group E was increased(P<0.05).(6)There was no significant difference in the incidence of hypotension between the two groups within 48 hours after operation(P>0.05).Compared with group C,the incidence of nausea and vomiting in group E decreased within 48 hours after operation(P<0.05).Conclusions:(1)The application of epidural analgesia pump after epidural combined with general anesthesia can effectively reduce the inflammatory response and postoperative insulin resistance index in patients undergoing laparoscopic radical gastrectomy.(2)The application of epidural analgesia pump after epidural combined with general anesthesia can effectively reduce the pain response of patients undergoing laparoscopic radical gastrectomy,reduce the dosage of remifentanil during anesthesia,and improve the satisfaction of patients with analgesia.(3)The application of epidural analgesia pump after epidural combined with general anesthesia can effectively improve the early postoperative recovery index and shorten the hospitalization days of patients undergoing laparoscopic radical gastrectomy.