| Objective:To investigate the difference of analgesic effect between epidural injection of low-dose morphine and transversus abdominis plane block(TAPB)in patients undergoing rectal cancer surgery.Methods:Ninety patients who were hospitalized for laparoscopic rectal cancer surgery under general anesthesia in Ganzhou Cancer Hospital from May 2022 to December2022 were selected for the study.The age was 18-75 years,ASA classification was grade I and II,and body mass index was about 18-28 kg/m~2.The study subjects were divided into 3 groups using the random number table method,namely the epidural morphine group(EA group),the transversus abdominis plane block group(TAP group)and single intravenous self-administered analgesia group(PCIA group),with 30 cases in each group.All patients underwent surgery under general anesthesia with conventional tracheal intubation.Patients in the PCIA group were given intravenous self-administered analgesia with sufentanil after the operation.In the EA group,a single injection of morphine(morphine dissolved in saline to a concentration of 0.15mg/m L in 10 m L solution)was administered via an indwelling epidural catheter at the end of the operation and sufentanil PCIA was administered postoperatively.In the TAP group,ultrasound-guided bilateral posterior TAPB(20 m L each side)with0.375%ropivacaine and postoperative PCIA were administered at the end of the operation.Recording of resting and active Numeric Rating Scales(NRS)at 6 h,12 h,24 h and 48 h after surgery,sufentanil dosage,time to first postoperative analgesic pump press,number of effective analgesic pump presses at 48 h,time of first getting out of bed,length of hospitalization and time of first exhaust.Assessment and recording of 40-item postoperative recovery quality scores(Qo R-40)and 24 h postoperative C-reactive protein(CRP)levels on day 1 before and day 1 after surgery for all three groups.Document the occurrence of postoperative adverse reactions in the three groups.Results:1.There were no statistical differences in gender,age,BMI,ASA,time of surgery,or surgical procedure between the three groups(P>0.05).2.Compared with the PCIA group,the NRS scores at 6 h,12 h and 24 h postoperatively at rest and during activity were significantly lower in the EA and TAP groups(P<0.05),and at 6 h postoperatively,the NRS scores at rest were higher in the TAP group than in the EA group(P<0.05),and at 6 h and 12 h during activity the NRS scores in the EA group were significantly lower than in the TAP group(P<0.05).3.When comparing between the PCIA,EA and TAP groups,sufentanil dosage at24 h and 48 h postoperatively was significantly lower in the EA and TAP groups than in the PCIA group(P<0.05),and lower in the EA group compared to the TAP group(P<0.05).4.Compared with the PCIA group,the first press of the analgesic pump was significantly longer in the EA and TAP groups,and the total number of presses within48 h was significantly lower(P<0.05),and the first press in the EA group was longer than that in the TAP group(P<0.05).5.The postoperative Qo R-40 scores were higher in both the EA and TAP groups than in the PCIA group(P<0.05),and the postoperative Qo R-40 score was higher in the EA group than in the TAP group(P<0.05).6.Comparing the three groups,the PCIA group had a significantly longer time to first ventilate and get out of bed after surgery than the EA and TAP group(P<0.05),and the EA group had a shorter time to get out of bed than the TAP group(P<0.05).7.There were no differences in postoperative length of stay,incidence of adverse events,or CRP levels between the three groups that were statistically significant.Conclusion:For patients undergoing laparoscopic rectal cancer surgery,compared with PCIA,Low dose morphine epidural injection with posterior approach TAPB provides better analgesia at 24 h postoperatively,reduce opioid consumption after surgery,facilitate early ambulation,accelerate intestinal function recovery,and do not increase adverse events.In addition,epidural injection of low-dose morphine has a more optimized analgesic effect than posterior TAPB within 12 h after surgery,which is worthy of clinical application and promotion. |
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