| Part ⅠEffect of transversus abdominis plane block combined with two general anesthesia methods on postoperative nausea and vomiting after gynecological laparoscopic surgeryObjective: This study observes the occurrence of PONV after transversus abdominis plane block combined with two traditional general anesthesia methods（namely:intravenous combined anesthesia and total intravenous anesthesia）after gynecological laparoscopic surgery.The combination is proposed to be recommended for clinical use.Methods:1.This study is a prospective,randomized,single-blind controlled study.A total of 120 patients undergoing elective gynecological laparoscopic surgery in the Affiliated Hospital of Zunyi Medical University were collected as subjects,and they were randomly divided into TAPB combined with intravenous inhalation combined anesthesia group（composite group）and TAPB combined with total intravenous anesthesia group（intravenous group）,anesthesia induction program The block method is the same as the transverse abdominis plane block.The anesthesia maintenance plan: the compound group is set with sevoflurane with an inhalation concentration of 1.0 MAC,and the propofol +remifentanil pump speed is adjusted according to the operation needs to maintain the depth of anesthesia;intravenous group Continuous intravenous pump injection of propofol 4-10 mg/（kg.h）+ remifentanil 0.25-4 ug/（kg.min）to maintain the depth of anesthesia.Both groups were given metoclopramide 10 mg at the end of the operation,and PCIA analgesic formula was used after surgery: sufentanil 2 ug/kg + metoclopramide30 mg dissolved in 100 ml of normal saline.2.The subjects who were formally included in the study were taken as the starting point of the experiment and monitored and recorded according to the following indicators:（1）Baseline data: demographic information such as age,height,weight,BMI,ethnicity,etc.;general information such as ASA classification,disease diagnosis,etc.;anesthesia and surgical information such as anesthesia time,operation time,and intraoperative access;entrance hemodynamics.（2）The main indicators of the study: PONV information such as the total incidence of PONV,the classification of PONV,the number of PONV occurrences in each time period after surgery,the number of occurrences of PONV in each time period,and the situation of additional drugs after surgery.（3）Research secondary indicators: adverse events such as the incidence of complications related to opioid analgesics,the incidence of complications related to TAPB operations,mortality and other adverse events;perioperative hemodynamic changes;intraoperative anesthetic use;Recovery period such as recovery time and PACU stay time;follow-up information such as total hospital stay,postoperative hospital stay and medical expenses;postoperative VAS score,analgesic consumption and postoperative analgesic pump compressions and other analgesic evaluation.Results:1.120 patients were included,60 in each group,14 cases were excluded,and the dropout rate was 11.7%.Among them,8 cases were excluded in the composite group and 6 cases in the venous group.Finally,106 patients were included in the study for data sorting and analysis,including 52 cases in the composite group and 54 cases in the venous group.2.Baseline data There was no statistically significant difference between the two groups for demographic information,general information such as ASA classification,disease diagnosis and entry hemodynamics,and anesthesia and surgery information such as anesthesia time,operation time and intraoperative access volume（P>0.05）.3.Research the main indicators（1）The total incidence and classification of PONV: No PONV occurred in the two groups of patients during the PACU observation period;the total incidence of PONV in the composite group was significantly higher than that of the intravenous group within 48 hours after surgery（P<0.05）;There was no statistically significant difference in the incidence of grade 3 PONV between the two groups（P>0.05）;there were no cases of grade 4 or higher in the two groups;comparison between the composite groups,the incidence of grade 1 PONV was significantly higher than that of grade 2（P< 0.05）.（2）The number of occurrences of PONV in each time period: The number of occurrences of PONV in the composite group was significantly higher than that in the intravenous group 2-4h after operation（P<0.05）;the number of occurrences of PONV was 0-2h,4-6h,and 6-24 h after operation.The difference between the two groups was not statistically significant（P>0.05）;there was no PONV in the two groups of subjects24-48 h after surgery.（3）The number of occurrences of PONV in each time period: The number of occurrences of PONV in the compound group was significantly higher than that in the intravenous group 2-4h after the operation（P < 0.05）;the time period of 0-2h,4-6h,6-24 h and 24-48 h after operation There was no statistically significant difference in the number of occurrences of PONV between the two groups（P>0.05）.（4）Postoperative addition of drugs: Postoperative addition of antiemetics and analgesics,the difference between the two groups was not statistically significant（P>0.05）.4.Research on secondary indicators（1）The incidence of complications related to opioid analgesics: constipation,urine retention,skin itching and excessive sedation,etc.,the difference between the two groups was not statistically significant（P>0.05）;the incidence of complications related to TAPB operation: There were zero cases of puncture infection or hematoma,allergic reactions and local anesthetic poisoning in the two groups;no deaths occurred in the two groups.（2）Hemodynamic changes during the perioperative period: There was no significant difference between the two groups in hemodynamic indicators such as HR,MAP and SpO2 at each observation time point（P>0.05）.（3）Postoperative anesthetic use: Intraoperative consumption of sufentanil,etomidate,rocuronium,propofol,remifentanil and analgesic pump sufentanil,there was no statistical difference between the two groups Academic significance（P>0.05）.（4）Information on the recovery period and follow-up period: the resuscitation time,PACU stay time,total hospitalization days and medical expenses,etc.,the difference between the two groups was not statistically significant（P>0.05）;the postoperative hospital stay was significantly longer in the composite group than in the intravenous group（P<0.05）.（5）Analgesia evaluation: There was no significant difference between the two groups in VAS scores at 2h,4h,6h,24 h,48h,postoperative sufentanil consumption and the number of analgesic pump compressions（P>0.05）.Conclusion: TAPB combined with intravenous inhalation combined anesthesia and total intravenous anesthesia in gynecological laparoscopic surgery all have PONV,but TAPB combined with total intravenous anesthesia has a lower PONV,so it is recommended to choose TAPB combined with total intravenous anesthesia for clinical use.Part ⅡEffect of transversus abdominis plane block combined with total intravenous anesthesia on postoperative pain,nausea and vomiting after gynecological laparoscopic surgery and the control effect of opioidsObjective: This study is based on the first part of the preferred TAPB combined with total intravenous anesthesia.In the case of performing TAPB combined with PCIA analgesia before gynecological laparoscopic surgery,to observe whether the application of intravenous analgesia load after the operation can be cancelled to reduce The amount of opioids can reduce the side effects of PONV.Methods:1.This study is a prospective,randomized,double-blind controlled study.A total of 120 patients undergoing elective gynecological laparoscopic surgery in the Affiliated Hospital of Zunyi Medical University were collected as subjects and randomly divided into TAPB+ F group and TAPB + NS group.The anesthesia plan for the two groups of patients was based on the first part of the optimal TAPB combined with total intravenous anesthesia.The anesthesia maintenance plan was intraoperative continuous intravenous pump injection of propofol 4-10 mg/（kg.h）+ remifentanil 0.25-4 ug/（kg.min）Maintain the depth of anesthesia.The transversus abdominis plane block method was the same.The TAPB + F group was given an intravenous analgesic load of 10 ug at the end of the operation;the TAPB + NS group was given NS 2ml at the end of the operation.Two patients were given 10 mg of metoclopramide at the end of the operation.The postoperative PCIA analgesic formula was: sufentanil 2 ug/kg + metoclopramide 30 mg dissolved in 100 ml of normal saline.2.Taking the formally included research subjects as the starting point of the experiment,monitoring and recording are carried out according to the following indicators:（1）Baseline data: history of smoking,history of PONV or motion sickness,use of intraoperative anesthetics,etc.The rest is the same as the first part.（2）The main indicators of the study: postoperative VAS score,consumption of analgesic drugs,and postoperative analgesic pump compressions;the same as the first part.（3）Study the secondary indicators: perioperative analgesic use,catheter removal time,drainage tube removal time,etc.The rest is the same as the first part.Results:1.120 patients were included,60 cases in each group,11 cases were eliminated,and the dropout rate was 9.2%.Among them,6 cases were eliminated in the TAPB + F group,5cases were eliminated in the TAPB + NS group,and finally 109 patients were included in the study for data sorting and analysis,including 54 cases in the TAPB + F group and 55 cases in the TAPB + NS group.2.Baseline data Demographic information,general information such as ASA classification,disease diagnosis and entry hemodynamics,anesthesia and surgery information such as anesthesia time,operation time,intraoperative access and intraoperative anesthetic drug use,there was no statistically significant difference between the two groups（P>0.05）.3.Research the main indicators（1）Analgesia evaluation: There was no significant difference between the two groups in VAS scores at 2h,4h,6h,24 h,48h,the consumption of analgesic drug sufentanil,and the number of analgesic pump compressions（P>0.05）.（2）Occurrence of PONV: The total incidence and classification of PONV: There was no PONV in the two groups of patients during the PACU observation period;the total incidence of PONV within 48 hours after surgery,the difference between the two groups was not statistically significant（P>0.05）,but TAPB + F The incidence of PONV in the group was 44.4%,and the incidence of PONV in the TAPB + NS group was 34.5%;there was no significant difference in the incidence of grade 1,grade 2 and grade 3 PONV between the two groups（P>0.05）;PONV level 4;the number and frequency of occurrence of PONV in the 0-2h,2-4h,4-6h,6-24 h,24-48 h period after the operation,the difference between the two groups was not statistically significant（P>0.05）.（3）Postoperative addition of drugs: Postoperative addition of antiemetics and analgesics,the difference between the two groups was not statistically significant（P>0.05）.4.Research on secondary indicators（1）The incidence of complications related to opioid analgesics: constipation,urine retention,skin itching and excessive sedation,etc.,the difference between the two groups was not statistically significant（P>0.05）;the incidence of complications related to TAPB operation: There were zero cases of puncture infection or hematoma,allergic reactions and local anesthetic poisoning in the two groups;no deaths occurred in the two groups.（2）Hemodynamic changes during the perioperative period: HR and SpO2 at each observation time point,there was no significant difference between the two groups（P>0.05）;at the end of the operation,the MAP of the TAPB + F group was significantly lower than that of TAPB + NS Group（P<0.05）;the other observation points MAP between the two groups were not statistically significant（P>0.05）.（3）Perioperative analgesic use: the total consumption of sufentanil and sufentanil in the TAPB + F group was significantly higher than that in the TAPB + NS group（P<0.05）;analgesic pump sufentanil There was no statistically significant difference between the two groups（P>0.05）.（4）Information on the recovery period and follow-up period: the resuscitation time and PACU stay time in the TAPB + F group were significantly longer than those in the TAPB+ NS group（P<0.05）;the time of catheter removal,drainage tube removal,total hospital days,postoperative There was no statistically significant difference between the two groups in hospitalization days and medical expenses（P>0.05）.Conclusion:TAPB combined with total intravenous anesthesia can cancel the intravenous analgesic load and use opioids at the end of gynecological laparoscopic surgery.It has no obvious effect on postoperative pain and PONV,but it can shorten the postoperative recovery time and save opioids.Part Ⅲ Effect of Transverse Abdominal Muscle Plane Block Combined with Opioid-less PCIA on Pain,Postoperative Nausea and Vomiting after Gynecological Laparoscopic SurgeryObjective: This study intends to observe whether patients undergoing gynaecological laparoscopic surgery under the condition of TAPB as the basic analgesia,can they adopt opioid analgesia?Methods:1.This study is a prospective,randomized,double-blind controlled study.A total of 72 patients undergoing elective gynecological laparoscopic surgery in the Affiliated Hospital of Zunyi Medical University were collected as subjects and randomly divided into TAPB+ S group and TAPB + N group.The anesthesia maintenance program of the two groups of patients was the first part of the optimal TAPB combined with total intravenous anesthesia.The transversus abdominis plane block method was the same in the two groups.The intravenous analgesic load was cancelled after the operation.The two patients were given metoclopr after the operation.Amine 10 mg.Based on the results of the second part of the trial,it was found that the TAPB combined with an analgesic formula of 2ug/kg sufentanil after PCIA can provide patients with good analgesia,but at the same time the incidence of PONV is higher.In this part of the experiment,we used a less opioid PCIA analgesic formula based on the relative potency ratio of the drug’s equivalent strength.TAPB + S group: Sufentanil 1ug/kg + metoclopramide 30 mg dissolved in 100 ml normal saline;TAPB + N Group: Nabuphine 1mg/kg +metoclopramide 30 mg dissolved in 100 ml normal saline.2.Taking the formally included research subjects as the starting point of the experiment,monitor and record according to the following indicators:（1）Baseline data: Same as the second part.（2）The main indicators of the study: Ramsay sedation score after surgery;the rest is the same as the second part.（3）Research secondary indicators: hemodynamic changes at each observation point during the follow-up period;the rest is the same as the second part.Results:1.72 cases of patients were included,36 cases in each group,7 cases were eliminated,and the dropout rate was 9.7%.Among them,4 cases were eliminated in the TAPB+S group and 3 cases were eliminated in the TAPB + N group.Finally,65 patients were included in the study for data sorting and analysis,including 32 cases in the TAPB + S group and 33 cases in the TAPB + N group.2.Baseline data There was no statistically significant difference between the two groups of demographic information,general information such as ASA classification,disease diagnosis,and entry hemodynamics,anesthesia and surgical information such as anesthesia time,operation time,intraoperative access,and intraoperative anesthetic use（P >0.05）.3.Research the main indicators（1）Analgesia evaluation: The VAS scores of the TAPB + S group at 2h,4h,and 6h after the operation were significantly higher than those of the TAPB + N group（P<0.05）;there was no significant difference in the VAS scores between the two groups at 24 h and 48 h after the operation（P>0.05）;2h,4h,6h,24 h,48h postoperative analgesic consumption of sufentanil/nalbuphine and postoperative analgesic pump compression times,there was no significant difference between the two groups（P>0.05）.（2）Postoperative Ramsay sedation score: The Ramsay sedation score of the TAPB + S group was significantly higher than that of the TAPB + N group at 2h,4h,and 6h after the operation（P<0.05）;there was no significant difference in the Ramsay sedation score between the two groups at 24 h and 48 h after the operation.Significance（P>0.05）.（3）The occurrence of PONV: There was no PONV in the two groups of patients during the PACU observation period;the total incidence of PONV within 48 hours after the operation,the difference between the two groups was not statistically significant（P>0.05）;Grade 1,Grade 2 and Grade 3 PONV Incidence rate,the difference between the two groups was not statistically significant（P>0.05）;there was no PONV level 4 in the two groups;postoperative 0-2h,2-4h,4-6h,6-24 h,24-48 h time period There was no significant difference in the number and frequency of PONV between the two groups（P>0.05）.（4）Postoperative addition of drugs: Postoperative addition of antiemetics and analgesics,the difference between the two groups was not statistically significant（P>0.05）.4.Research on secondary indicators（1）Adverse events: The incidence of complications related to opioid analgesics,constipation,urine retention and skin itching,etc.,was not statistically different between the two groups（P>0.05）;the incidence of complications related to TAPB operation,Puncture infection or hematoma,allergic reactions and local anesthetic poisoning,etc.,the number of cases of patients in both groups were zero;the number of cases of mortality in both groups was zero.（2）Hemodynamic changes during the follow-up period: at each observation time point,there was no significant difference between the two groups of hemodynamic indicators such as HR,MAP,and SpO2（P>0.05）.（3）Information on the recovery period and follow-up period: resuscitation time,PACU stay time,catheter removal time,drainage catheter removal time,total hospital stay,postoperative hospital stay and medical expenses,etc.There was no statistically significant difference between the two groups（P>0.05）.Conclusion:TAPB is used as a basic analgesia before gynecological laparoscopic surgery.Postoperative analgesia with less opioid can provide patients with excellent analgesia,but PONV still occurs,and opioids are not the main cause of PONV. |
PDF Full Text Request