Effect Of Multipoint Subcostal Transversus Abdominis Plane Block On Postoperative Recovery In Patients Undergoing Biliary Tract Surgery

Objective:To assess the effect of ultrasound-guided multipoint subcostal transversus abdominis plane?TAP?block on postoperative recovery in patients undergoing biliary tract surgery.Method:Sixty Patients undergoing biliary tract surgery were enrolled,randomly divided into three groups:multipoint subcostal TAP group?group A?,single point subcostal TAP group?group B?and control group?group C?,20 patients in each group.After induction of anesthesia,patients in group A received ultrasound-guided multi-point subcostal TAP block,the patients in group B received ultrasound-guided single-point subcostal TAP block,the patients in group B were not received TAP block;All patients received patient controlled intravenous analgesia?PCIA?after surgery.The change of pressure and heart before and after five minutes of the incision were recorded.The change of BP,HR,SPO_2,VAS score and Ramsay score at 1,2,6,8,12,24 and 48 hours after surgery were recorded.The frequency of PCIA compressions,opioid dosage,the first time of PCIA compressions,rescue analgesic administrations and adverse reactions were recorded.Postoperative bed rest time,first exhaust time,the time 0f catheter removal and the length of hospital stay were recorded.Plasma interleukin-6?IL-6?,tumor necrosis factor-??TNF-??and C reactive protein?CRP?levels were measured before and 0h,4h,and 24h after surgery.Result:Compared with group C,the changes of intraoperative hemodynamics were significantly smaller in group A and group B?P<0.05?,the VAS scores at 1,2,6,8,and 12 h after surgery were significantly decreased in group A and group B?P<0.05?,the frequency of PCIA compressions,the dosage of sufentanil,Postoperative bed rest time,first exhaust time and the length of hospital stay after surgery were significantly reduced in group A and group B?P<0.05?,IL-6?TNF-??CRP level at4and 24 hours after surgery was significantly decreased in group A and group B?P<0.05?.Compared with group B,the VAS scores at 1,2,6h after surgery were significantly decreased in group A?P<0.05?,the frequency of PCIA compressions,the dosage of sufentanil,Postoperative bed rest time,first exhaust time and the length of hospital stay after surgery were significantly reduced in group A?P<0.05?,IL-6?TNF-??CRP level at4 and 24 hours after surgery was significantly decreased in group A?P<0.05?.There were 2 cases of nausea and vomiting in group C.One patient in group B developed nausea but no vomiting.There were 4 cases of nausea and 2 cases of vomiting in group C.Conclusion:Both ultrasound-guided multipoint subcostal TAP block and single-point subcostal transversus TAP block can effectively alleviate the pain and reduce inflammatory mediators in patients undergoing biliary tract surgery.However,Multipoint subcostal TAP block has more obvious advantages and is more conducive to the rapid recovery of patients after surgery.