Application Of Transversus Abdominis Plane Block Combined With Target Controlled Infusion Of Propofol And Remifentanil In Partial Hepatectomy

Objective:To investigate the effect of transversus abdominis plane block combined with propofol and remifentanil target controlled infusion(TCI)in open partial hepatectomy.Methods:Sixty patients scheduled for partial hepatectomy from June 2018 to November 2019 were randomly divided into experimental group(n=30)and control group(n=30).The control group was induced and maintained by TCI with propofol and remifentanil.The experimental group was combined with the transversus abdominis plane block on the basis of the control group.Patients in both groups received bolus injection of cisatracurium to maintain surgical relaxation.And the BIS was maintained between 40 to 60 during operation.The mean arterial pressure(MAP),heart rate(HR)and bispectral index(BIS)of two groups were recorded before anesthesia(T0),at the loss of conscious(T1),immediate after endotracheal intubation(T2),immediate after skin incision(T3),1 h after skin incision(T4)and at the end of operation(T5).The intraoperative consumption of propofol and reminfentainl,time to eye opening,time to endotracheal extubation and hospitalization time were recorded.The VAS scores of rest and deep breath before operation and at 1 h,6h and 24 h after operation were recorded.Pressing times of analgesic pump and the consumption of sufentanil during 24 h after operation were recorded.Adverse reactions such as dizziness,drowsiness,nausea and vomiting,abnormal liver and kidney function and respiratory depression were recorded.In this study,IBM SPSS Statistics 26 statistical analysis software was used for statistical analysis,and GraphPad Prism 8.0.2 software was used for drawing.Results:(1)There was no significant difference in MAP,HR and BIS between the two groups at all time points(P>0.05).Analysis within each group showed that the MAP and HR at T1-T5 were lower than T0,the BIS at T0 was higher than other time points and the BIS at T2-T5 is lower than T1(P<0.05).(2)Compared with the control group,the intraoperative consumption of remifentanil was decreased in the experimental group(P<0.05).No difference was found in the intraoperative consumption of propofol between the control group and experiment group(P>0.05).Compared with control group,the time to eye opening and endotracheal extubation were shorter in the experiment group(P<0.05).There was no significant difference in hospitalization time betweenthe two groups(P>0.05).(3)There was no significant difference in VAS scores at rest before operation and at 1 h after operation in two groups(P>0.05).Compared with the control group,the VAS scores at rest at 6 h and 24 h after operation was decreased in the experiment group(P<0.05).Analysis within each group showed that the VAS scores at rest at 1 h,6 h and 24 h after operation were increased compared with it before operation(P<0.05).Meanwhile,compared with 1 h after operation,the VAS scores at rest at 6h and 24 h after operation was increased in two groups.No difference was found in the VAS scores during deep breath before operation and at 1 h after operation between the control group and experiment group(P>0.05).There was no significant difference in VAS scores before operation and at 1 h after operation in two groups(P>0.05).Compared with control group,the VAS scores during deep breath at 6 h and 24 h after operation were decreased in the experiment group(P<0.05).Analysis within each group showed that the VAS scores during deep breath at 1 h,6 h and 24 h after operation were increased compared with it before operation.In the experimental group,there was no significant difference in the three time periods after operation(P>0.05).While in the control group,the VAS scores during deep breath at 6 h and 24 h after operation was increased compared with it at 1 h after operation(P<0.05).(4)Compared with the control group,the pressing times of analgesic pump and the consumption of sufentanil during 24 h after operation was decreased in theexperiment group(P<0.05).(5)There was no significant difference in postoperative adverse reactions between the two groups(P>0.05).Conclusion:Transversus abdominis plane block combined with target controlled infusion of propofol and remifentanil in open partial hepatectomy can reduce the consumption of perioperative opioid,shorten the awaking time,relieve postoperative pain and reduce the adverse reactions.Moreover,it is helpful in quick recovery after operation.