Effect Of Esketamine As Ropivacaine Adjuvant On Postoperative Analgesia Of Ultrasound-guided Quadratus Lumborum Block In Patients With Gynecological Tumor

Objective:To observe the effects of esketamine as an adjuvant to ropivacaine on the analgesic effect of ultrasound-guided quadratus lumborum block after transabdominal gynecologic oncology surgery,and to compare it with dexmedetomidine,a commonly used clinical adjuvant,to explore an anesthetic protocol more conducive to prolonging the analgesic time after quadratus lumborum block Method:Ninety patients who were to undergo transabdominal total hysterectomy and systemic lymph node dissection in our gynecology department were selected and divided into three groups by the random number table method,with 30 patients in each group.quadratus lumborum block group(Q group): 0.3% ropivacaine + 0.9%saline configured into 50 m L solution,esketamine group(QK group): 0.3%ropivacaine + 0.25mg/kg esketamine + 0.9% saline configured into 50 m L solution,dexmedetomidine group(QD group): 0.3% ropivacaine + 0.5μg/kg dexmedetomidine+ 0.9% Physiological saline was configured into a 50 m L solution.Patients underwent lateral quadratus lumborum block at the end of surgery.Primary observation: opioid consumption within 48 h postoperatively.Secondary observation indexes: time to first compression of patients with self-controlled intravenous analgesia after surgery,number of effective compressions,number of cases of remedial drug tramadol use,BCS scores,resting and motor status NRS scores,time to first anal venting after surgery,time to first walking on the floor,total length of hospital stay,occurrence of adverse effects such as postoperative nausea and vomiting,dizziness,skin pruritus,lower limb weakness,sinus bradycardia,hypotension,irritable hallucinations,etc.Demographic and perioperative data,including: age,height,weight,BMI,operative time,intraoperative bleeding,total intraoperative sufentanil and remifentanil use,and time to tracheal extubation.Result:(1)The differences in age,weight,body mass index,operating time,intraoperative bleeding,sufentanil and remifentanil dosage were not statistically significant(P>0.05).(2)The postoperative hydromorphone consumption in QD and QK groups was lower than that in Q group,and the postoperative hydromorphone consumption in QK group was lower than that in QD group,and the difference was statistically significant(P<0.01).The first postoperative analgesic pump pressure time was significantly longer in QD and QK groups than in Q group,and the first postoperative analgesic pump pressure time was significantly longer in QK group than in QD group(P < 0.01);the effective number of postoperative analgesic pump pressure in QD and QK groups was lower than that in Q group.The number of effective postoperative analgesic pump compressions was lower in the QD and QK groups than in the QK group,and the number of effective postoperative analgesic pump compressions was higher in the QD group than in the QK group(P < 0.01).There was no statistically significant difference in the number of cases of postoperative tramadol remedy in the three groups(P > 0.05).(3)At the time of leaving the PACU,the resting and motor NRS pain scores of patients in the QD and QK groups were lower than those in the Q group at 4 and 24 hours postoperatively(P<0.01);the differences in resting and motor NRS pain scores of patients in the three groups at 48 hours postoperatively were not statistically significant(P>0.05).The differences in BCS comfort scores at the time of leaving the PACU,4 hours,24 hours and 48 hours postoperatively were not statistically significant among the three groups(P>0.05).(4)The number of hypotensive occurrences at 48 h postoperatively was higher in the QD group than in the Q and QK groups(P<0.0167).(5)There were no statistically significant differences in the time of tracheal tube removal,time of first anal venting,time of first bed activity,adverse effects such as nausea and vomiting,dizziness,skin pruritus,lower limb weakness,sinus slowing,irritable hallucinations and length of hospital stay in the three groups(P>0.05).Conclusion:(1)The application of esketamine as an adjuvant to ropivacaine in quadratus lumborum block reduced perioperative opioid consumption,prolonged the postoperative analgesia of quadratus lumborum block,and enhanced the postoperative analgesic effect of quadratus lumborum block in patients undergoing transabdominal gynecologic oncology surgery without significant adverse effects.(2)Compared with the addition of dexmedetomidine to quadratus lumborum block,ropivacaine compounded with esketamine in quadratus lumborum block provided longer analgesia without adverse effects such as hypotension.