Impact On Patients With Laparoscopic Hysterectomy Using Multi-model Analgesia

Objective:To observe the effect of different multi-modal analgesia(MMA)on patients after laparoscopic total hysterectomy under Enhanced Recovery after Surgery(ERAS)protocol during perioperative period.Methods:Collecting data of 359 patients with adenomyosis and adenomyoma underwent laparoscopic total hysterectomy from gynecology ward of Shengjing hospital affiliated to China medical university during September 2017 to October 2019.All patients meeting inclusion and exclusion criteria were included in ERAS protocol after admission.Each group was given 50 mg of flurbiprofen ester intravenously as pre-emptiv analgesia 30 minutes before operation.General anesthesia was induced routinely during the operation.100 mg of flurbiprofen ester was given intravenously once a day as routine analgesia.According to different combinations of analgesic methods,including subcutaneous injection of ropivacaine during surgery,transversus abdominis plane block(TAPB)during surgery and patient controlled intravenous analgesia(PCIA)after surgery,all cases are divided into 6 groups.Group A: Inject 20 ml of 0.5% ropivacaine subcutaneously during the operation.Group B: Inject 15 ml 0.5% ropivacaine into the transverse abdominis plane under the guidance of ultrasound during the operation.Group C: Use 100 ml opioid PCIA at the rate of 2ml/H after surgery,the dosage was calculated according to the body weight.Group D: Inject 20 ml of 0.5% ropivacaine subcutaneously during the operation.Meanwhile,use 100 ml opioid PCIA after surgery.Group E: Inject 15 ml 0.5% ropivacaine into the transverse abdominis plane under the guidance of ultrasound during the operation.Meanwhile,use 100 ml opioid PCIA after surgery.Group F: No special treatment during and after operation.Record perioperative blood pressure,heart rate,white blood cell count,percentage of neutrophils,d-dimer and hemoglobin,postoperative drainage volume within 24 hours,first exhaust time after surgery,postoperative activity time,complications,hospital stay and expense,visual analogue score(VAS)at 2H,6H,12 H,24H and 48 H after surgery.Results:There was no statistic difference in age and body weight(P>0.05)among each group.There was no statistic difference in each group’s VAS at 2H,6H and 24H(P>0.05).At 12 H after the operation,the proportion of VAS≤3 in group A was higher than that in group B,group C,group E and group F(P<0.05).At 48 H after the operation,the proportion of VAS≤3 in each group was higher than 96.1%.The proportion of VAS≤2 in group E was lower than that in group A,group B,group C and group F(P<0.05).There was no statistic difference in perioperative blood pressure,heart rate,white blood cell count,neutrophil ratio,and hemoglobin(P>0.05)among each group.There was no statistic difference in postoperative activity time,first exhaust time after surgery,postoperative drainage volume within 24 hours,hospital stay(P>0.05)among each group.There was no statistic difference in the incidence of postoperative complications(including fever,nausea and vomiting)in group A,group B and group F(P>0.05).The incidence of complications in group D was significantly higher than that in group C and group E(P<0.05).Fever is the most common complication among each groups.The hospital expense of group A was lower than any other groups(P<0.05).Conclusion:Pre-emptiv analgesia combined with subcutaneous injection of ropivacaine during surgery is more suitable for laparoscopic total hysterectomy under ERAS protocol.