| BACKGROUND: General anesthesia combined with transversus abdominis plane block(TAPB)is a common anesthesia method for Laparoscopic Hysterectomy.TAPB,with infiltration of local anesthetics into the plane between internal oblique and transversus abdominis,has been extensively investigated as a method of postoperative pain control,The causes of postoperative pain in laparoscopic surgery are complicated,including incision,visceral traction and pneumoperitoneum are the main factors.However,well-established TAPB blocks could significantly reduce somatic pain.Reducing visceral pain and postoperative nausea and vomiting caused by abdominal organ pulling can improve the postoperative satisfaction of patients undergoing gynecologic endoscopic surgery.Despite there are many peroperative analgesic strategies pain may persist after surgery which leading to unrecognized complications of chronic postoperative pain(CPSP).Hysterectomy is one of the most common surgical options in the world,but few studies have focused on chronic pain after hysterectomy.Even a low incidence of CPSP after hysterectomy can cause serious public health problems.In this study,we aimed to compare the intensity of postoperative pain and the intensity and prevalence of chronic pain after Laparoscopic Hysterectomy.OBJECTIVE: We aimed to observe the efficacy of preemptive analgesia of nalbuphine combine with TAPB on postoperative pain and chronic postsurgical pain in Laparoscopic Hysterectomy.METHODS: A total of 120 patients on laparoscopic hysterectomy.,aged over 18,with BMI18.5-24.5,were obtained.Using the random number table method,the patients were randomly divided into 2 groups: nalbuphine 20 mg pretreatment group(group A)and control group(group B).All patients in the two groups received laryngeal mask general anesthesia and TAPB before anesthesia induction.TAPB operation of all patients was completed by the same anesthesiologist.Anesthesia induction and maintenance medication were the same.The dosage of propofol,remifentanil and vasoactive drugs used in the two groups were recorded.2.The NRS(digital pain score)score and the amount of sufentanil used in the period of 1h,3h,6h and 12 h after rest and exercise were recorded.3.Occurrence of postoperative skin itching,respiratory depression and other adverse reactions.4.NRS score at rest and exercise 3,4 and 6 months after surgery.RESULTS: The results from 117 patients(59 patients in the group A and 58 patients in the group B)were obtained.Compared with group B,the dosage of remifentanil and propofol injection decreased in group A,and the difference was statistically significant.(P < 0.05).The dosage of sufentanil in the analgesic pump was different between the two groups 1h and 3h after the operation,but the difference was not statistically significant(P > 0.05).The dosage of sufentanil was different in the patients at 6h and 12 h postoperatively and the difference was statistically significant(P < 0.05).The utilization rate of vasoactive drugs was different in group A and group B,with 10.2% in group A and 20.7 in group B.However,the difference was not statistically significant(=2.487 P=0.12).The incidence of skin pruritus and respiratory depression in group A was lower than that in group B,and the difference was statistically significant.(P < 0.05)the NRS scores after rest and exercise 1,3,6 and 12 h after the operation were different between the two groups(P < 0.05).The incidence and intensity of chronic pain were different in group A and group B at 2,4 and 6 months after surgery,but there was no statistical significance(P > 0.05).CONCLUSION: Different preoperative analgesic methods have different analgesic mechanisms.Combining TAPB with nalbuphine can better relieve intraoperative and postoperative pain and reduce the incidence of postoperative adverse reactions,but there is no significant improvement in the intensity and incidence of chronic pain after laparoscopic hysterectomy. |
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