| Objective To explore the implementation of multimodel preventive analgesia in the enhanced recovery after surgery of gastric cancer patients after radical gastrectomy and its influence on the postoperative recovery,and analyze the treatment effects.Methods Sixty patients diagnosed as gastric cancer by preoperative gastroscopic biopsy at the People’s Hospital of Ningxia Hui Autonomous Region from November 2018 to December 2019 were randomly divided into two groups:the multimodal preventive analgesia group and the control group,each group has 30 patients.All patients were diagnosed with gastric cancer by gastroscopic biopsy before surgery and underwent laparoscopic assisted radical gastric cancer treatment,all the patients were undergoing radical gastrectomy including Distal gastrectomy combined with Billroth I anastomy、major gastrectomy with BillrothⅡanastomy、total gastrectomy with esophagojejunastomy etc.During the operation,the patients in both groups were performed intravenous general anesthesia and tracheal intubation,and given gastric tube,jejunal nutrition tube and urinary catheter.The urinary catheter and gastric tube were removed within 24 hours after the surgery,in addition,the patients in both groups were treated with the same method except analgesic methods.In the multimodal preventive analgesia group,10 mg dexamethasone and 40 mg parecoxib were injection by intravenous before anesthesia induction,ropivacaine(0.375%)were injected around incision of abdominal wall when making an skin incision、entering the abdominal cavity and suturing the skin incision,the patients were treated with praecoxib intravenously for3 days(40 mg each time,twice a day)and routinely use intravenous analgesia pump(sufentanil 100ug+tropisetron hydrochloride 8mg+dizosin 10mg+0.9%NaCl=120ml).The patients in the control group were given intravenous analgesia pump only after surgery.Remove the intravenous analgesic pump after the medication in the pump is used up or when the patient’s pain score is assessed to be<3.The components and dose of analgesic drugs were same with multimodal preventive analgesia group.The numerical rating scale(NRS)、athens insomnia scale(AIS)、the number of cases of postoperative ambulation(>6 h for every day)、the first flatus and defecate time、the length of hospitalization and the postoperative adverse reactions and complications were recorded between the two groups,evaluate the effect of two analgesic methods on postoperative rehabilitation of gastric cancer patients.Results The scores of the NRS at postoperative day 1,2 and 3 were 2.97±0.89,2.48±0.64 and 1.91±0.56 in the preventive analgesia group,and 5.25±0.58,4.34±0.86 and3.10±0.91 in the control group,with a significant difference between the two groups(t=-23.22,-19.56,-12.69;P<0.05).The scores of the AIS at postoperative day 1,2and 3 were 3.70±0.58,3.15±0.54 and 4.20±1.78 in the preventive analgesia group,and5.89±1.44,6.42±3.35 and 7.29±4.19 in the control group,with a significant difference between the two groups(t=-17.45,-12.34,-8.39;P<0.05).The number of cases of postoperative ambulation that more than 6 hours in the multimodal preventive analgesia group was significantly more than that in control group(χ~2=5.55 for day 1,χ~2=6.24 for day 2,χ~2=7.95for day 3;P<0.05).The time of flatus,defecation and duration of hospital stay in the multimodal preventive analgesia group were significantly shorter than that in control group(t=-3.50,-4.55,-6.58;P<0.05).The number of cases of nausea and vomiting,skin itch,wound infection,pulmonary infection and DVT were 3,1,4,3 and 2 cases in the multimodal preventive analgesia group,compared with 8,6,6,8 and 4 cases in the control group,showing no significant difference between the two groups(χ~2=2.783,4.043,0.480,2.783,0.741;P>0.05).While,the proportion of patients with urinary retention in the multimodal preventive analgesia group were significantly lower than that in control group(χ~2=4.800,P=0.028).In addition,there were no adverse reactions and complications such as respiratory depression,hypotension and intestinal obstruction in both groups.Conclusion The use of multimodal preventive analgesia in perioperative period can significantly reduce the degree of incision pain in patients with gastric cancer,relieve the insomnia status caused by postoperative pain.The number of patients who get out of bed at early stage is significantly increased,and there is no obvious adverse reaction,which promotes the recovery of intestinal function,shortens the postoperative hospital stay,and is conducive to the rapid recovery of gastric cancer patients. |
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