Evaluation Of The Analgesic Effect Of Ropivacaine Combined With Dexamethasone In Ultrasound-guided TAPB After Laparoscopic Cholecystectomy

Objective: To evaluate the postoperative analgesic effect of different concentrations of ropivacaine alone or in combination with dexamethasone in ultrasound-guided transversus abdominis plane block(TAPB)combined with patient-controlled intravenous analgesia(PCIA)in laparoscopic cholecystectomy.Methods: Eighty patients with laparoscopic cholecystectomy(LC),ASA grade I-II,aged18-70 years,were randomly divided into four groups: 0.25% ropivacaine group(group A),0.375% ropivacaine group(group B),0.25% ropivacaine + dexamethasone group(group C)and 0.375% ropivacaine + dexamethasone group(group D).Each group included 20 patients.All patients in the four groups were given intravenous and inhalational balanced anesthesia.Bilateral transversus abdominis plane block(TAPB)was performed at the same site by subcostal + axillary midline approach under ultrasound guidance in all patients after anesthesia induction.All patients received PCIA after operation.VRS,VAS1,VAS2 and NRS scores at 30min(T1),1h(T2),2h(T3),4h(T4),6h(T5)and 24h(T6)after operation were recorded respectively.Dosage of PCIA at different time points between T2-T6 after operation was recorded.The use of analgesics in ward within 24 hours after operation was recorded.The time of intestinal exhaust after operation was recorded.The incidence rate of complications of postoperative nausea and vomiting(PONV),skin itching,urinary retention and local anesthetic poisoning were recorded.Comparing the differences among the four groups.Results: There was no significant difference in VRS,VAS1,VAS2 and NRS scores between the four groups at different time points after operation(P?0.05).There was no difference between groups.The total dosage of PCIA in group C within 24 hours was less than that in group A,but the difference was no significant(P?0.05).The incidence of PONV in group C was less than that in group A,group D was less than that in group B.The difference was statistically significant(P<0.05).There was no significant difference in the incidence of PONV between group A and group B,between group C and group D.The time of intestinal ventilation after operation in group C was less than that in group A,and the difference was statistically significant(P<0.05).There was no significant difference in the number of cases of analgesic remedies in the ward within 24 hours after operation between the four groups.There was no difference between groups.No adverse reactions such as urinary retention,skin itching and local anesthetic poisoning occurred in all four groups.Conclusion: The analgesic effect of 0.25% ropivacaine and 0.375% ropivacaine is comparable When TAPB is used for postoperative analgesia in LC.Therefore,it is suggested that 0.25% ropivacaine be used for TAPB in clinic to improve the safety of local anesthesia.At the same time,ropivacaine combined with dexamethasone did not enhance the analgesic effect of TAPB.But could significantly reduce the incidence of PONV in patients.