The Application Of Ultrasound Guided Continnous Posterior Bilateral Transversus Abdominis Plane Analgesia In Laparoscopic Colonrectal Surgery

Objective:We evaluate the analgesic effect of transverses abdominis plane infusion as a new analgesic technique through comparision with thoracic epidural block in the application of laparoscopic colonrectal surgery.Methods:60 patients undergoing laparoscopic colonrectal surgery were randomly assigned to receive continuous transverse abdominal plane analgesia?TAPB?or thoracic epidural anesthesia?TEA?before surgery.TAPB group received ultrasound-guided posterior bilateral TAP B and catheters with a total of 0.375%ropivacaine 0.3 ml/Kg each side and added 0.375%ropivacaine0.1 ml/Kg each side every 2 h during operation and received infusion of 0.2%ropivacaine for 48 h postoperation.TEA group received thoracic puncture and catheter with load dosage of 0.375%ropivacaine 8¹0 ml and added 0.375%ropivacaine 4⁵ ml every 1¹.5 h.The TEA group received infusion of 0.2%ropivacaine 3⁴ ml/h for 48 h.Data collection included changes of VAS scores at rest and with coughing,blood pressure and heart rate,TAP B level,tramadol requirements,patients,satisfaction,the occurrence of adverse reactions and recovery after surgery.Results:Ultimately 59 patients?TAPB=29 vs TEA=30?completed the study.The VAS scores at 12 h,24h with coughing of TAPB group were higher than that of TEA group?P<0.05?.The systolic blood pressures?SBP?,diastolic blood pressures?DBP?and heart rates of TEA group at time points postoperation were lower than TAPB group?P<0.05?.The posterior TAPB covered T₅^L₁,receded over 6 h postoperation and then maintained T₁₀^T₁₂.There were no differences between groups for the tramadol consumptions,the first press time and total press times of analgesia pump?P>0.05?.We found no differences between the groups in patient satisfaction and incidence of nausea and vomiting,paralyzed lower limb and postoperative hypotension?P>0.05?.The total adverse reaction incidence of TEA group was higher than that of TAPB group?P<0.05?.Time to return of bowel function,time of removal of the urinary catheter,time to get out of bed and duration of postoperative hospital stay showed no differences between groups?P>0.05?.Except for one patient who developed postoperative hypotension,no patients had symptoms of local anaesthetic toxicity.Conclusion:Compared with TEA,continuous posterior TAP B can provide patients at rest with similar analgesia after laparoscopic colorectal surgery with little influence on heamodynamics postoperation.But analgesic effect of TAPB is insufficient for pain during coughing compared with epidural analgesia.