Comparative Study Of Preventive Analgesia Combined With Different Local Anesthesia Methods In Postoperative Analgesia After Gynecological Laparoscopy

Objective:The purpose of this study is to explore the application of multi mode combined analgesia in postoperative analgesia after gynecological laparoscopy,and to try to find a safe,effective and comfortable postoperative analgesic way through preventive treatment of narcotic analgesics,combined operation with local invasive anesthesia of abdominal wound or transversus abdominis plane block under ultrasound guidance.Methods:Selected patients under general anesthesia in gynecological laparoscopic surgery in 82 cases as the research object,18⁶5 years old,weighing 42⁷8kg,American Society of anesthesiologists?ASA?grade I or II.Exclude liver and kidney dysfunction,cardiovascular dysfunction,coagulation dysfunction,aspirin allergy,gastrointestinal ulcer history,ropivacaine allergy history,long-term drinking and drug abuse history,and chronic pain history.They were randomly divided into transverse abdominis block group?group T,n=46?and local infiltration group?group L,n=36?,the two groups were routine preoperative visit,after entering the conventional open peripheral venous access,monitoring heart rate,ECG,blood pressure,pulse oxygen call at the end of gas saturation,partial pressure of carbon dioxide.Based on 2 hours,the 82 patients were re grouped according to the length of operation time:group A?operation time less than 2h,n=50?,group B?operation time>=2h,n=32?.The total intravenous anesthesia,anesthesia induction:followed by intravenous midazolam0.05mg/kg,sufentanil 0.5?g/kg,etomidate 0.2⁰.3 mg/kg,rocuronium 0.6 mg/kg,oxygen to nitrogen for 3 minutes,after the patient's eyelash reflection disappeared into the laryngeal mask,and then the machine was ventilated by mechanical ventilation.Parameter setting:tidal volume 8¹0 ml/kg,respiration frequency 12 times/min,suction ratio 1:2,oxygen flow 2L/min,FiO2 100%,adjust ventilation parameters according to pneumoperitoneum pressure and end expiratory carbon dioxide partial pressure.Maintenance of anesthesia:the remifentanil infusion rate is set to 0.2?g/?kg-min?,propofol infusion rate set at 4-8mg/?kg-h?,intermittent intravenous injection surgery Luoku bromide to maintain the patient's muscle,adjust dosage according to the patient's weight and blood pressure etc..Flflurbiprofen was injected 50 mg intravenously 15 minutes before surgical incision,and flurbiprofen 50 mg and granisetron 3 mg were injected into the anterior suture.In group T,bilateral abdominal transverse fascia block was performed under ultrasound guidance in the anesthesia recovery room?PACU?at the end of operation.The drug was 0.25%ropivacaine hydrochloric 20ml/on each side,and L group was treated by local infiltration anesthesia with 0.5%ropivacaine hydrochloride 20ml around the wound.At the end of operation,when the patient's spontaneous breathing resumed and his consciousness was clear,the laryngeal mask airway was removed.The basic vital signs of the patients were observed,and they were sent back to the wards after being stabilized.All patients did not give the disposable intravenous analgesia pump.All patients did not give the disposable intravenous analgesia pump.Record the operation start time,end time,induction time,removal of laryngeal mask remifentanil and sufentanil in time,intraoperative amount were recorded 5 minutes after the removal of the laryngeal mask?T₁?,4 hours after operation?T₂?,8 hours after operation?T₃?,12 hours after operation?T₄?,after 24 hours operation?T₅?static and dynamic visual simulation score of the 5point?Visual Analogue,Scale,VAS?,comfort score?Bruggrmann comfort,scale,BCS?,Ramsay sedation score and adverse reactions such as nausea and vomiting.Results:There was no significant difference in height,weight,age,anesthesia time,operative time,extubation time,sufentanil and remifentanil between the two groups?all P>0.05?.Compared with group L,the VAS scores of group T at T₂ and T₃ were significantly decreased at these two time points?P<0.05 or P<0.01?,but at other time points,there was no significant difference in VAS scores between the two groups?P>0.05?.There was no significant difference in the Ramsay score between the two groups at all time points?P>0.05?.At the time of T₅,the score of BCS in group T was higher than that in group L?P<0.05?.At other time points,there was no significant difference in BCS score between the two groups?P>0.05?,and there was no significant difference in the incidence of nausea and vomiting between the two groups?P>0.05?.Compared with group B,the VAS scores of group A at T₁,T₂,T₃ and T₅were significantly decreased at these four time points?P<0.05 or P<0.01?,and there was no significant difference in VAS score between two groups at T₄ point?P>0.05?.Compared with group B,the BCS scores of group A increased significantly at these two time points of T₂ and T₃?P<0.05?.There was no significant difference in BCS scores between two groups?P>0.05?at other time points.There was no significant difference in the Ramsay score between the two groups at all time points?P>0.05?.Conclusion:T group and L group were lower in patients with gynecological laparoscopic surgery after 24 hour VAS score,can better meet the demand of patients with postoperative pain,improve patient comfort and satisfaction;The effect of the T group was better for the early postoperative pain;With the prolongation of the operation time,the pain intensity of the patients increased slightly,and the comfort decreased in the early post operation.