Bilateral Ultrasound-guided Erector Spinae Plane Block Combined With Intravenous For Postoperative Analgesia In Patient Undergoing Laparoscopic Subtotal Gastrectomy

Objective:Comparison between bilateral ultrasound-guided erector spinae plane block(ESPB)and epidural block techniques for postoperative analgesia in patients undergoing laparoscopic subtotal gastrectomy.Methods:60 patients undergoing elective laparoscopic subtotal gastrectomy in Rizhao people’s Hospital from January to October 2020 were divided into two groups stochastically,bilateral ESPB group(group A)and PECA group(group B),30 cases in each group.After admission,ECG,Sp O2,Pet CO2,and pulse and heart rate were detected in 2 groups.Radial artery pressure was measured invasivly under local anesthesia,and central venous access was opened by puncture of right internal jugular vein.Before anesthesia induction,ESPB was performed under ultrasound guidance in group A,and 0.25% ropivacaine injection 25 ml was injected between the erector spinal muscle and the transverse process T8.Anesthesia induction: Endotracheal intubation was induced by sufentanil 0.3 g/kg,propofol 2mg/kg,cisatacurium 0.2mg/kg sequence routine,and the anesthesia machine was connected.Inhaled oxygen concentration of 60%,flow rate of 2L/min,tidal volume of 6-8ml/kg,and frequency of 10-12 times /min were set,and respiratory parameters were adjusted timely according to pet CO2.Anesthesia maintenance: Sevoflurane inhalation maintenance,remifentanil0.1ug/(kg·min),cisatracuride 0.1mg/(kg·h)continuous pumping.The infusion rate was adjusted according to the depth of anesthesia,BIS was maintained between 45 and 55,and sufentanil was added according to the analgesia needs.At the end of surgery,homeopathic atracurium,sevoflurane and remifentanil were stopped sequentially,and the patient was waited for extubation.Group A was connected to PCIA pump for analgesia after surgery(sufentanil 100ug+ ondansetron 16 mg,diluted to 100 ml with normal saline,background dose 2ml/h,single self-control analgesia dose 1ml,locking time 15min);group B was given epidural morphine 2mg half an hour before abdominal closure,and was connected to PCEA pump for analgesia after surgery(0.2% ropivacaine +0.04mg/ml morphine,diluted to 100 ml with normal saline.Background dose 2ml/h,single self-control analgesia dose 1ml,locking time 15min).Rest and movement VAS scores were recorded at 2h,6h,8h,12 h and 24 h after surgery(pain was divided into 11 grades from 0 to 10:0 represented no pain and 10 represented severe pain.Ask the patient to choose a scale from 0 to 10 to represent their pain.)Postoperative hypotension,urinary retention,nausea and vomiting,skin pruritus and other adverse reactions were recorded.Patients’ satisfaction with postoperative analgesia was recorded(1 represents dissatisfaction;A score of 2 represents basic satisfaction;A score of 3represents satisfaction;4 is very satisfied).SPSS 25.0 statistical software was used for statistical analysis.Measurement data were expressed as mean ± standard deviation(’ x±s),t-test was used,and analysis of variance was used for comparison between groups.The statistical data were tested by χ2 test.P < 0.05 indicated a statistically significant difference.Results:The VAS scores in group A were higher than those in group B at 2h after surgery,at 6h after surgery,at 8h after surgery,at 12 h after surgery,at 24 h after surgery(P>0.05).The incidence of hypotension and urinary retention in group A was lower than that of group B(P<0.05).There was no statistical difference in the incidence of nausea and skin itch between the 2 groups(P >0.05).The satisfaction score of group A was higher than that of group B(P>0.05).Conclusions:Bilateral ESPB combined with PCIA for postoperative analgesia after laparoscopic subtotal gastrectomy can achieve the same effect as epidural analgesia,and the incidence of adverse reactions is lower,and patient satisfaction is high.